Immunoglobulins A, G, M
| 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. Immunoglobulins A, G, M | |
| 2. | |
| 3. | |
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| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
IGGAM
Test Workstation :
SCYEL
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
1.0 mL (minimum 0.7 mL)
Cause for Rejection:
Lipemia
Storage:
Frozen
Availability:
Mon, Wed, Fri (0800-1600)
Methodology:
Nephelometry
Special Instructions:
Do not use serum separator tube. Specimen must be in lab by 1300 for same day results.
Lab/Phone:
330-543-8484
TAT:
1-3 days
Additional Info:
Reference ranges available under individual tests
CPT Code:
82784
