Hepatitis A IgM Antibody
| 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. Hepatitis A IgM Antibody | |
| 2. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
HEPAM
Test Workstation :
E8011
Specimen Type:
Blood
Tube Type:
SST (serum separator tube,no anticoagulant)
Collection Volume:
3.0 mL (minimum 1.5 mL)
Minimum Volume:
1.5 mL
Preferred Volume:
3 mL
Storage:
Shipping- Send Refrigerated; Storage- Room Temp: 7 days; Refrigerated: 14 days; Frozen: 3 months
Availability:
24 hours/day, 7 days/week
Methodology:
Roche- u-capture test principle
Lab/Phone:
330-543-8418
TAT:
4 hours
CPT Code:
86709
