Adenovirus PCR, Quantitative (non-blood specimens)

Centralized Core Laboratory - Mayo Clinic Laboratories : Send Out

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. Adenovirus PCR, Quantitative (non-blood specimens)
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

ADPCR

Test Workstation :

MAYO

Specimen Type:

Respiratory Specimen, Plasma, Serum, fluid, BAL, Sputum, Urine, Bone Marrow

Collection Volume:

Acceptable specimens: 1 mL respiratory specimen in M4, 1 mL fluid, 1 mL Urine, 2.5 ml Bone Marrow or Whole blood in a lavender (EDTA) or yellow (ACD)tube

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Real-Time PCR

Lab/Phone:

330-543-8418

TAT:

1-5 days

Additional Info:

Reference range: <500 copies/mL

CPT Code:

87799

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Adenovirus PCR, Quantitative (non-blood specimens)

Centralized Core Laboratory - Mayo Clinic Laboratories : Send Out

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