Alkaline Phosphatase Isoenzymes

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. Alkaline Phosphatase Isoenzymes
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Test ID/Workstation :

APISO MAYO

Specimen Type:

Blood

Tube Type:

Gold top SST (serum separator tube, no anticoagulant)

Collection Volume:

2.5 mL (minimum 1.5 mL)

Storage:

Frozen

Availability:

Sent to reference lab

Methodology:

Photometric, p-Nitrophenol Phosphate; Electrophoresis

Lab/Phone:

330-543-8418

TAT:

2-4 days

Additional Info:

Reference range is available on patient report Dats Performed Alkaline Phosphatase: Monday through Sunday; Continuously Alkaline Phosphatase Isoenzymes: Monday through Friday

CPT Code:

84075, 84080

Panel Includes:

Alkaline Phosphatase; Bone%; Bone U/L; Liver%; Liver U/L; Intestinal%; Intestinal U/L, Placental Isoenzymes

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Alkaline Phosphatase Isoenzymes

Centralized Core Laboratory : Chemistry

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