CAH 6 Pediatric Profile
| 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. CAH 6 Pediatric Profile | |
| 2. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
CAH6
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
9.0 mL
Minimum Volume:
5.0 mL
Cause for Rejection:
Collected in a gel tube
Storage:
Frozen
Availability:
Sent to reference lab, Days performed Mon,Wed
Methodology:
High Pressure Liquid Chromatography/Tandem Mass Spectrometry (HPLC-MS/MS)
Special Instructions:
Separate serum from cells within 1 hour.
Lab/Phone:
330-543-8418
TAT:
4-8 days
CPT Code:
82157, 82634, 82533, 82626, 82633, 84143, 84144, 83498, 84403
Profile Includes:
Androstenedione, 11 Desoxycortisol (Specific S), Cortisol, Dehydroepiandrosterone (DHEA), Deoxycorticosterone (DOC), 17-OH Pregnenolone, Progesterone, 17-Alpha-OH-Progesterone, and Testosterone
