Protein S Activity
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. Protein S Activity | |
2. | |
3. | |
4. | |
5. | |
6. |
SPECIMEN INFO |
Collection Date & Time: |
Collected By: |
Hospital: |
- Days Performed: Monday through Friday; 12 p.m.
- Centrifuge, remove plasma, and centrifuge again.
Please send 1 mL frozen citrated plasma.
- Males: 65-160%
- Females
- <50 years: 50-160%
- or =50 years: 65-160%