Raji Cell Assay
| PATIENT INFO |
| Patient Name: |
| Medical Record #: |
| 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. Raji Cell Assay | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
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Test ID :
RAJI
Test Workstation :
CLEVE
Specimen Type:
Blood
Tube Type:
Gold top SST (serum separator tube, no anticoagulant)
Collection Volume:
2.5 mL (minimum 1.5 mL)
Cause for Rejection:
Non frozen samples or samples exposed to repeated freeze/thaw cycles
Storage:
Frozen
Availability:
Sent to reference lab
Methodology:
Flow Cytometry (FC)
Special Instructions:
Allow complete clotting of red blood cells up to 1 hour, then separate serum from cells within 30 minutes and freeze immediately.
Lab/Phone:
330-543-8418
TAT:
3-11 days
Additional Info:
Reference range available on Patient report
CPT Code:
86332
