Thyroxine 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. Thyroxine Binding Globulin | |
| 2. | |
| 3. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
TBG
Test Workstation :
MAYO
Specimen Type:
Blood-Serum
Tube Type:
Red top (no anticoagulant) tube
Alternate Tube Type:
SST
Collection Volume:
2.5 mL
Minimum Volume:
1.0 mL
Cause for Rejection:
Grossly hemolyzed specimen
Storage:
Refrigerated
Availability:
Sent to Reference Laboratory
Methodology:
Solid-Phase Chemiluminescent Assay
Lab/Phone:
330-543-8418
TAT:
1-3 days
Additional Info:
Reference range available on patient report
CPT Code:
84442
Synonyms:
TBG (ThyroxineBinding Globulin)
TBG by Immunoassay
Thyroid Binding Globulin
