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Bordetella Pertussis Ab, IgG

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. Bordetella Pertussis Ab, IgG
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

BPGAB / Mayo

Specimen Type:

Blood

Tube Type:

Gold top SST (Serum Separator) tube or Red top (no anticoagulant) tube

Collection Volume:

2.5 mL (minimum 1.5 mL)

Storage:

Refrigerated

Availability:

Sent to Reference laboratory

Methodology:

Enzyme-Linked Immunosorbent Assay (ELISA)

Lab/Phone:

330-543-8418

TAT:

1-4 days

Additional Info:

Reference Value:

> or =100 IU/mL (positive)

> or = 40-<100 IU/mL (borderline)

<40 IU/mL (negative)

CPT Code:

86615

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