Neurotransmitter Profile, CSF
| 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. Neurotransmitter Profile, CSF | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
NTCSF
Test Workstation :
MAYO
Specimen Type:
CSF
Tube Type:
Medical Neurogenetics collection kit required.
Collection Volume:
Collect 4.5 mL CSF.
Storage:
Frozen
Availability:
Sent to Reference Laboratory
Methodology:
High Performance Liquid Chromatography-Electrochemistry & Fluorescences
Special Instructions:
Fill each tube in collection kit to the marked line with required volumes Tube #1: 0.5 mL, Tubes #2#5:1.0 mL each; leave tube # visible.
Lab/Phone:
330-543-8418
TAT:
14-18 Days
Additional Info:
Reference range available on patient report
CPT Code:
82542 (x3), 83150, 83497
Panel Includes:
Panel includes:
5-Methyltetrahydrofolate,
5-Hydroxyindoleacetic acid,
Homovanillic acid,
3-O-methlydopa,
Tetrahydrobiopterin, and
Neopterin
