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C1 Esterase Inhibitor Functional

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. C1 Esterase Inhibitor Functional
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

C1EST MAYO

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

2.5 mL (minimum 0.25 mL)

Cause for Rejection:

Storage:

Frozen

Availability:

Sent to reference lab

Methodology:

Enzyme Immunoassay (EIA)

Special Instructions:

Immediately after drawing specimen place on wet ice.

Lab/Phone:

330-543-8418

TAT:

1-5 days

Additional Info:

Reference range available on patient report

CPT Code:

83520

Synonyms:

While we are ranked among the best children's hospitals in the country, it's our compassionate approach to treatment that makes us truly exceptional. Through a combination of revolutionary treatments and extraordinary patient experiences, our care does more than heal. It brings the entire family together for emotional support and understanding across multiple locations to reach you in the community where you live. Learn more...