Primidone
| 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. Primidone | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
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Test ID :
PRIMI
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
1.5 mL (minimum 1.0 mL)
Cause for Rejection:
Gross hemolysis
Storage:
Refrigerated
Availability:
Sent to Reference Laboratory
Methodology:
Primidone: Immunoassay
Phenobarbital: Kinetic Interaction of Microparticles in a Solution (KIMS)
Lab/Phone:
330-543-8418
TAT:
1 day
Additional Info:
Phenobarbital (metabolite) determination is performed also for proper interpretation.
Reference Values:
PRIMIDONE
Therapeutic: 5.0-12.0 mcg/mL
Critical value: > or = 15.0 mcg/mL
PHENOBARBITAL
Therapeutic: 10.0-40.0 mcg/mL
Critical value: > or = 60.0 mcg/mL
CPT Code:
80184, 80188
Panel Includes:
Primidone
Phenobarbital
Synonyms:
Barbita, Luminal, Mysoline, Solfoton
