TSH with reflex T4FR
| 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. TSH with reflex T4FR | |
| 2. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
TSHR
Test Workstation :
E8011
Specimen Type:
Blood
Tube Type:
Green top (lithium heparin) tube
Collection Volume:
2.0 mL (minimum 1.5 mL)
Minimum Volume:
500 uL
Preferred Volume:
1.5 mL
Storage:
Shipping- Send Refrigerated; Storage- Room Temp: 5 days; Refrigerated: 7 days; Frozen: 30 days
Availability:
24 hours/day, 7 days/week
Methodology:
Roche-ECLIA
Lab/Phone:
330-543-8418
TAT:
4 hours
Additional Info:
Reference range is age dependent, available on patient report
CPT Code:
84443, if reflexed 84439
Panel Includes:
TSH with reflex to T4FR
Synonyms:
Thyroid Stim Hormone; Thryotropin (Stim) Hormone
