CMV IgM Ab

Infectious Disease Laboratories : Immunology

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. CMV IgM Ab
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

CMVIM VIR4

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

3.0 mL (minimum 1.0 mL)

Cause for Rejection:

Hemolyzed, lipemic or icteric specimen

Storage:

Refrigerated

Availability:

Thurs

Methodology:

Enzyme Immunoassay

Lab/Phone:

330-543-8576

TAT:

1-7 days

Additional Info:

Ref. range:

<0.90 = Neg

0.90-1.09 = Equivocal

>/=1.1 = Pos

CPT Code:

86645

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