ANA Ab Screen
| 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. ANA Ab Screen | |
| 2. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
ANASN
Test Workstation :
VIR4
Specimen Type:
3 mL whole blood collected in one no anticoagulant (red top) tube.
Minimum Volume:
Specimen minimum volume is 1 mL.
Cause for Rejection:
Hemolyzed, lipemic or icteric specimen,insufficient quantity, drawn in incorrect tube.
Storage:
Transport blood at room temperature. Upon arrival in laboratory, store at room temperature for no more than 24 hours. If specimen is to be stored longer than 24 hours, it should be refrigerated for up to 7 days.
Availability:
Mon-Fri (0700-1600)
Methodology:
Immunofluorescence (IFA)
Special Instructions:
Positive ANA Ab Screens will be titered.
Lab/Phone:
330-543-4863
TAT:
72 hours
CPT Code:
86038
Synonyms:
Antinuclear antibody screen
