Collagen Binding VWF
| 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. Collagen Binding VWF | |
| 2. | |
| 3. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
CBVWF
Test Workstation :
BCOWI
Specimen Type:
Blood
Tube Type:
Blue top(citrated)tube
Collection Volume:
2.7 mL
Storage:
Frozen
Availability:
Sent to Reference lab
Methodology:
Enzyme-Linked Immunosorbent Assay (ELISA)
Special Instructions:
If collected at an offsite location, send by a STAT Courier to Hospital lab
Lab/Phone:
330-543-8418
TAT:
7-10 Days
Additional Info:
Reference range: 56-214 IU/dL
CPT Code:
83520
