Aminolevulinic Acid, U
| 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. Aminolevulinic Acid, U | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
ALAC
Test Workstation :
MAYO
Specimen Type:
Urine
Tube Type:
Urine Container
Collection Volume:
2.0 mL From a random urine collection
Minimum Volume:
1.0 mL
Storage:
Refrigerated
Availability:
Sent to Mayo Medical Laboratory
Methodology:
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Special Instructions:
1. Patient should abstain from alcohol for 24 hours prior to collection.
Lab/Phone:
330-543-8418
Additional Info:
CPT Code:
82135
