Vitamin B6
| 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. Vitamin B6 | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
VITB6
Test Workstation :
MAYO
Specimen Type:
Blood - Plasma
Tube Type:
Green top (sodium heparin) tube
Collection Volume:
3.0 mL
Minimum Volume:
1.9 mL
Cause for Rejection:
Specimen not protected from light.
Storage:
Frozen
Availability:
Sent to reference lab
Methodology:
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Special Instructions:
Remove plasma from cells ASAP. Protect specimen from light. Specimen should be collected following an overnight (1214 hour) fast. Patient must not consume alcohol or vitamin supplements within 24 hours prior to collection.
Indicate plasma on tube.
For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly).
Lab/Phone:
330-543-8418
TAT:
3-7 days
Additional Info:
Reference range available on patient report
CPT Code:
82542
Synonyms:
Pyridoxal 5Phosphate (PLP), Pyridoxic Acid, Soft B6PA
