Leptospira Ab, IgM
| 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. Leptospira Ab, IgM | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
LEPTM
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Red Top (no anticoagulant) tube
Collection Volume:
1.0 mL
Minimum Volume:
0.3 mL
Cause for Rejection:
Gross hemolysis, gross lipemia
Storage:
Refrigerated
Availability:
Sent to Reference Laboratory
Methodology:
Enzyme-Linked Immunoassay Dot (Immunodot)
Lab/Phone:
330-543-8418
TAT:
1-5 days
Additional Info:
Reference Value: Negative
CPT Code:
86720
