Venoms Allergen Profile
| 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. Venoms Allergen Profile | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
INSEC
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Red top ( no anticoagulant) tube
Collection Volume:
1.5 mL
Minimum Volume:
1.2 mL
Storage:
Refrigerated
Availability:
Sent to mayo Medical Laboratory
Methodology:
Fluorescence Enzyme Immunoassay (FEIA)
Lab/Phone:
330-543-8418
Additional Info:
Reference range is available on patient report
CPT Code:
86003
Panel Includes:
Honeybee venom IgE,Yellow Faced Hornet IgE, Yellow Jacket Venom IgE, Wasp Venom, IgE, White Faced Hornet Venom IgE
