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Bartonella PCR

Infectious Disease Laboratories : Microbiology

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. Bartonella PCR
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Test ID/Workstation :

BAPCR Mayo

Specimen Type:

Whole Blood

Tube Type:

EDTA (lavender)tube

Collection Volume:

1.0 mL (0.5 mL minimum)

Cause for Rejection:

Icteric Specimens

Storage:

Refrigerated

Availability:

Sent to Reference Laboratory

Methodology:

Rapid Polymerase Chain Reaction (PCR)

Lab/Phone:

330-543-8418

TAT:

2-7 days

Additional Info:

Reference range: Negative Days Performed: Mon, Wed, Fri; 8 AM

CPT Code:

87798

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Bartonella PCR

Infectious Disease Laboratories : Microbiology

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