ALPS Panel by Flow Cytometry

Centralized Core Laboratory : Chemistry

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. ALPS Panel by Flow Cytometry
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

ALPSP / CINCI

Specimen Type:

Blood

Tube Type:

Purple top (EDTA) tube or Green top (Sodium heparin)tube

Collection Volume:

2.0 mL (minimum 1.0 mL)

Storage:

Ambient

Availability:

Sent to Reference laboratory

Methodology:

Flow Cytometry

Special Instructions:

Send to laboratory at room temperature. Do NOT refrigerate. Draw specimen Monday through Thursday only. Specimen must be received by laboratory by 14:00. Specimen stable for 24 hours

Lab/Phone:

330-543-8418

TAT:

2 days

Additional Info:

A concurrent CBC/Diff should be drawn with this assay or the results of a concurrent CBC/Diff should be sent so that absolute cell values can be reported.

CPT Code:

88184, 88185 x 10, 88188

While we are ranked among the best children's hospitals in the country, it's our compassionate approach to treatment that makes us truly exceptional. Through a combination of revolutionary treatments and extraordinary patient experiences, our care does more than heal. It brings the entire family together for emotional support and understanding across multiple locations to reach you in the community where you live. Learn more...

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There are 10 nurses in the picture.

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The five differences are:
– Phone color
– Coat pocket
– Stethoscope earpiece color
– Stethoscope bell dot
– Clipboard paper color

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The two matching doctors are 9 and 14.

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The correct path:

The Correct Path

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