Erythrocyte Sedimentation Rate
| 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. Erythrocyte Sedimentation Rate | |
| 2. | |
| 3. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
ESRAT
Test Workstation :
MCHM
Specimen Type:
Blood
Tube Type:
Purple top (EDTA) tube: Whole Blood
Collection Volume:
1.5 mL (minimum 1.0 mL)
Minimum Volume:
1 mL
Preferred Volume:
1.5 mL
Cause for Rejection:
Clotted specimens, hemolyzed specimens,
Specimens collected in microtainer tubes or tubes without pierceable cap.
Storage:
Refrigerated
Availability:
Daily, 24 hours
Methodology:
Direct measure of aggregation of red blood cells
Special Instructions:
Specimens must be collected by venipuncture in macro tubes; multiple microtainer tubes are NOT acceptable.
Lab/Phone:
330-543-8418
TAT:
2 hours
Additional Info:
Reference range:
Newborn: 0-2 mm/hr
Newborn to puberty: 3-13 mm/hr
Male <50 years old: <15 mm/hr
Female <50 years old: <20 mm/hr
Male >50 years old: <20 mm/hr
Female >50 years old: <30 mm/hr
CPT Code:
85652
Synonyms:
ESR
Sedimentation Rate
