Calcitonin
| 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. Calcitonin | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
- 1 month: < or =34
- 2 months: < or =31
- 3 months: < or =28
- 4 months: < or =26
- 5 months: < or =24
- 6 months: < or =22
- 7 months: < or =20
- 8 months: < or =19.0
- 9 months: < or =17.0
- 10 months: < or =16.0
- 11 months: < or =15.0
- 12-14 months: < or =14.0
- 15-17 months: < or =12.0
- 18-20 months: < or =10.0
- 21-23 months: < or =9.0
- 2 years: < or =8.0
- 3-9 years: < or =7.0
- 10-15 years: < or =6.0
- 16 years: < or =5.0
- Males: < or =14.3 pg/mL
- Females: < or =7.6 pg/mL

