Mucopolysaccharide QN, Random, Urine

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. Mucopolysaccharide QN, Random, Urine
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

MPSQU

Test Workstation :

MAYO

Specimen Type:

Urine

Tube Type:

Urine container

Collection Volume:

2 mL (minimum 1.0 mL) random urine

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Liquid chromatography-Tandem Mass Spectrometry (LC-MS/MS)

Special Instructions:

Patient's age and reason for referral are required for processing.

Lab/Phone:

330-543-8418

TAT:

8-15 days

Additional Info:

Reference range is available on patient report

CPT Code:

82570, 83864