Hypersens. pneumonitis Panel
| 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. Hypersens. pneumonitis Panel | |
| 2. | |
| 3. | |
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| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
HYPPN
Test Workstation :
CLEVE
Specimen Type:
Blood
Tube Type:
Gold top SST (serum separator tube, no anticoagulant)
Collection Volume:
2.5 mL (minimum 0.5 mL)
Storage:
Refrigerated
Availability:
Sent to Reference Laboratory
Methodology:
Immunodiffusion
Special Instructions:
Remove serum from cells within 2 hours of collection.
For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly).
Lab/Phone:
330-543-8418
TAT:
4-9 days
Additional Info:
Reference range is available on patient report
CPT Code:
86331(x4) 86606 (x2)
Panel Includes:
1.Aspergillus fumigatus #1 Ab Precipitin
2.Aspergillus fumigatus #6 Ab Precipitin
3.Aureobasidium pullulans Ab Precipitin
4.Pigeon serum Ab Precipitin
5.Micropolyspora faeni Ab Precipitin
6.Thermoactinomyces vulgaris #1 Ab Precipitin
