Lyme Disease Serology
| PATIENT INFO |
| Patient Name: |
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| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
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| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
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| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. Lyme Disease Serology | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
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Test ID :
LYMSR
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Red top tube-Serum
Collection Volume:
1.5 mL (minimum 1.0 mL)
Cause for Rejection:
Grossly hemolyzed, grossly lipemic
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Enzyme Linked Immunosorbent Assay (ELISA)
Lab/Phone:
330-543-8148
TAT:
1-4 days
Additional Info:
NOTE: If Lyme Disease Serology is positive, then Lyme Disease Antibody Confirmation by Western blot will be performed at an additional charge.
CPT Code:
86618, (86617x2 if Western blot performed)
Synonyms:
Borrelia Burgdorferi
