Chlamydia pneumoniae IgG, IgM, IgA Abs.
| 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. Chlamydia pneumoniae IgG, IgM, IgA Abs. | |
| 2. | |
| 3. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
CLPNE
Test Workstation :
CLEVE
Specimen Type:
Blood
Tube Type:
Gold top SST (serum separator tube, no anticoagulant)
Collection Volume:
2.5 mL (minimum 0.5 mL)
Cause for Rejection:
Grossly hemolyzed, lipemic or icteric specimens will be rejected.
Storage:
Ambient
Availability:
Sent to Reference Laboratory
Methodology:
Immunofluorescence
Special Instructions:
Lab Transfer serum to plastic screwcap vial
Lab/Phone:
330-543-8418
TAT:
2-4 days
Additional Info:
Reference range is available on patient report
CPT Code:
86631x2, 86632
Panel Includes:
Chlam pneumoniae IgG, IgM, & IgA Abs
Profile Includes:
C pneumonia IgG Ab
C pneumonia IgA Ab
C pneumonia IgM Ab
C pneumonia ABS interpretation
