Oligosaccharide Screen, Urine
| 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. Oligosaccharide Screen, Urine | |
| 2. | |
| 3. | |
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| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
OLIGU
Test Workstation :
MAYO
Specimen Type:
Urine
Tube Type:
Urine container
Collection Volume:
Adult 8.0 mL random urine (minimum 2.5 mL)
Pediatric 3.0 mL random urine (minimum 2.5 mL)
Storage:
Frozen
Availability:
Sent to reference lab
Methodology:
Matrix-Assisted Laser Desorption Ionization Time-of-Flight (MALDI-TOF) Mass Spectrometry
Special Instructions:
Collect a random urine specimen. No preservative. Immediately freeze specimen.
Patient's age is required. Include family history, clinical condition (asymptomatic or acute episode), diet, and drug therapy information.
Lab/Phone:
330-543-8418
TAT:
8-15 days
Additional Info:
Reference range is available on patient report
CPT Code:
84377
