Sex-hormone Binding Globulin
| 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. Sex-hormone Binding Globulin | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test Workstation :
Cobas e801
Specimen Type:
Blood
Tube Type:
Red Top- When collected as part of Testosterone, Free Panel (serum gel/SST are NOT acceptable)
Green Top (lithium heparin) tube
Collection Volume:
1 mL
Minimum Volume:
0.6 mL
Preferred Volume:
1 mL
Cause for Rejection:
Serum separator tube or serum gel
Storage:
Refrigerated
Availability:
24 hours/day, 7 days/week
Methodology:
Roche- ECLIA sandwich principle
Lab/Phone:
330-543-8418
TAT:
4 hours
Additional Info:
Ref. range is age dependent; available on patient report
CPT Code:
84270
