T4 Thyroxine Total Only, 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. T4 Thyroxine Total Only, Serum | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
T4TOT
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Gold Top SST (Serum Separator Tube)
Collection Volume:
2.5 mL
Minimum Volume:
1.9 mL
Cause for Rejection:
Grossly hemolyzed
Storage:
Refrigerated
Availability:
Sent to Reference Lab performed Monday through Friday
Methodology:
Electrochemiluminescence Immunoassay
Special Instructions:
This test cannot be used in patients receiving treatment with lipidlowering agents containing dextrothyroxine unless therapy is discontinued for 4 to 6 weeks to allow the physiological state to become reestablished prior to testing.
Lab/Phone:
330-543-8418
TAT:
1-3 days
Additional Info:
Reference Range: See reference lab ranges on report
CPT Code:
84436
Synonyms:
SynThyroid
T4, Serum
Tetraiodothyronine
Thyroid Hormone
Thyroxine, Total
T4 Total Only, S
Thyroxine
Thyroxine
