Vitamin K
| 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. Vitamin K | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
VITMK
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Alternate Tube Type:
SST
Collection Volume:
6.0 mL
Minimum Volume:
1.9 mL
Cause for Rejection:
Gross lipemia, specimen not protected from light
Storage:
Refrigerated
Availability:
Sent to Mayo Medical Laboratories
Methodology:
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Special Instructions:
Protect from light. Submit specimen in amber transport tube. Obtain specimen following an overnight (12 hour) fast. (Infants: draw prior to next feeding)
Lab/Phone:
330-543-8418
TAT:
2-5 days
Additional Info:
Reference range available on patient report
CPT Code:
84597
Synonyms:
Phylloquinone, Phytonadione, Mephyton, Phytomenadione, Synthex, Konakion
