Prostate Specific Antigen
| 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. Prostate Specific Antigen | |
| 2. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
PSA
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
2.5 mL
Minimum Volume:
2.0 mL
Cause for Rejection:
Gross hemolysis
Storage:
Frozen
Availability:
Sent to reference lab
Methodology:
Electrochemiluminescent Immunoassay (ECLIA)
Special Instructions:
Serum gel tubes should be centrifuged within 2 hours of collection.
If collected at an offsite location, send by a STAT Courier to Hospital lab
Lab/Phone:
330-543-8418
TAT:
1-3 days
Additional Info:
Reference range:
Female: Not applicable
<40 Years < or = 2.0 ng/mL
40-49 Years < or = 2.5 ng/mL
50-59 Years < or = 3.5 ng/mL
60-69 Years < or = 4.5 ng/mL
70-79 Years < or = 6.5 ng/mL
> or = 80 Years < or = 7.2 ng/mL
CPT Code:
84153
Synonyms:
PSA
