Selenium, Serum
| 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. Selenium, Serum | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
SELEN
Test Workstation :
MAYO
Specimen Type:
Blood - Serum
Tube Type:
Navy Blue(Trace Element-Serum No Additive)
Collection Volume:
Collect 2.0 mL (minimum 0.5 mL)
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Dynamic Reaction Cell-Inductively Coupled Plasma-Mass Spectrometry
Special Instructions:
Allow specimen to clot for 30 min at room temp. Pour specimen into a Mayo metalfree aliquot tube.
DO NOT PIPETTE
Lab/Phone:
330-543-8418
TAT:
1- 3 DAYS
Additional Info:
Reference range:
0-2 months: 45-90 mcg/L
3-6 months: 50-120 mcg/L
7-9 months: 60-120 mcg/L
10-12 months: 70-130 mcg/L
> 13 months-17 years: 70-150 mcg/L
> or = 18 years: 110-165 mcg/L
CPT Code:
84255
