Testosterone, Total
| 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. Testosterone, Total | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
TESTO
Test Workstation :
SHIMZ
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
2.5 mL
Minimum Volume:
0.6 mL
Cause for Rejection:
Grossly hemolyzed, Gross icterus, Gross lipemia, serum separator tube or serum gel.
Storage:
Refrigerated
Methodology:
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Special Instructions:
Patient's age and sex are required.
Lab/Phone:
330-543-0223
TAT:
3-5 days
Additional Info:
Ref. range is age & sex dependent; see pt report
CPT Code:
84403
