Centralized Core Laboratory - Mayo Clinic Laboratories :
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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. Lamotrigine
2.
3.
4.
5.
6.
SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
LAMOT
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
2.5 mL (minimum 1.5 mL)
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Special Instructions:
1. Draw blood immediately before next scheduled dose.
2. For sustainedrelease formulations only, draw blood a minimum of 12 hours after last dose.
3. Centrifuge within 2 hours of collection
Lab/Phone:
330-543-8418
TAT:
1-2 days
Additional Info:
Reference Range available on patient report
CPT Code:
80175
Synonyms:
Lamictal
Lamotrigine
Test ID/Workstation :
LAMOT
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
2.5 mL (minimum 1.5 mL)
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Special Instructions:
1. Draw blood immediately before next scheduled dose.
2. For sustainedrelease formulations only, draw blood a minimum of 12 hours after last dose.
3. Centrifuge within 2 hours of collection
Lab/Phone:
330-543-8418
TAT:
1-2 days
Additional Info:
Reference Range available on patient report
CPT Code:
80175
Synonyms:
Lamictal
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