Acylcarnitines, Plasma Quantitative

- : Metabolic Lab

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. Acylcarnitines, Plasma Quantitative
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

ACP

Test Workstation :

SHIMZ

Specimen Type:

Blood

Tube Type:

Green top (sodium or lithium heparin) tube. NO GEL Tubes.

Collection Volume:

1.5 mL (minimum 1.0 mL)

Cause for Rejection:

Specimen collected in a gel tube.

Storage:

Frozen

Availability:

Sent to reference lab

Methodology:

Flow Injection Analysis - Tandem Mass Spectrometry (FIA-MS/MS)

Special Instructions:

Patient's age is required on request form for processing.

Lab/Phone:

330-543-0223

TAT:

3-5 days

Additional Info:

Reference range is available on patient report

CPT Code:

82017

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Acylcarnitines, Plasma Quantitative

- : Metabolic Lab

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