We are experiencing exceptionally high volumes in our emergency rooms.
Every patient is important to us, and we are doing all we can to provide care quickly and efficiently.

C Peptide

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. C Peptide
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

CPEP MAYO

Specimen Type:

Blood

Tube Type:

Gold top SST (serum separator) or Red top (no anticoagulant) tube

Collection Volume:

2.5 mL (minimum 2.0 mL)

Storage:

Frozen

Availability:

Sent to reference lab

Methodology:

Electrochemiluminescence Immunoassay

Special Instructions:

Fasting specimen required. Centrifuge and aliquot within 2 hours of collection. For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly).

Lab/Phone:

330-543-8418

TAT:

1-3 days

Additional Info:

Reference range: 1.1-4.4 ng/mL

CPT Code:

84681

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