C3, Complement

Centralized Core Laboratory : Special 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. C3, Complement
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

C3 ACHM5

Specimen Type:

Blood

Tube Type:

Green top (lithium heparin) tube

Collection Volume:

2.0 mL (minimum 1.0 mL)

Storage:

Shipping-Send Refrigerated; Storage- Room Temp: 4 days; Refrigerated: 8 days; Frozen 8 days

Availability:

24 hours/day, 7 days/week

Methodology:

Roche-Immunoturbidometric

Lab/Phone:

330-543-8417

TAT:

4 hours

Additional Info:

Ref. range is age dependent; avail on patient report

CPT Code:

86160

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