Dilantin, Free and Total
| 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. Dilantin, Free and Total | |
| 2. | |
| 3. | |
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| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
DILFR
Test Workstation :
SUMMA
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
5.0 mL
Minimum Volume:
3.0 mL
Storage:
Refrigerated
Availability:
Sent to reference lab daily
Methodology:
Fluorescent Polarization Immunoassay
Lab/Phone:
330-543-8418
TAT:
24 hours
Additional Info:
Reference range is available on patient report
CPT Code:
80186
Synonyms:
Phenytoin Free and Total
