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Aminolevulinic Acid, U

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. Aminolevulinic Acid, U
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

ALAC MAYO

Specimen Type:

Urine

Tube Type:

Urine Container

Collection Volume:

2.0 mL (1.0 mL minimum)

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 and during testing. 2. Collect random urine specimen 3. Patient's age is required.

Lab/Phone:

330-543-8418

Additional Info:

Reference range:

<1 year: < or = 10nmol/mL

1-17 years: < or = 20 nmol/mL

> or = 18 years: < or = 15 nmol/mL

CPT Code:

82135

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