C Peptide
| 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 :
CPEP
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Gold top SST (serum separator) or Red top (no anticoagulant) tube
Collection Volume:
2.5 mL
Minimum Volume:
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
