Histoplasma Abs
| PATIENT INFO |
| Patient Name: |
| Medical Record #: |
| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
| Address: |
| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
| Ph: ( ) - Fax: ( ) - |
| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. Histoplasma Abs | |
| 2. | |
| 3. | |
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| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
HISTO
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Red Top (no anticoagulant) tube
Collection Volume:
1.5 mL
Cause for Rejection:
Gross hemolysis, gross lipemia
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Complement Fixation/Immunodiffusion (CF/ID)
Lab/Phone:
330-543-8418
TAT:
2-7 days
Additional Info:
Reference range is available on patient report
CPT Code:
86698x3
Panel Includes:
Histo Mycelial Ab-CF, Histo Yeast Ab-CF and Histoplasma Ab ID
