We are experiencing exceptionally high volumes in our emergency rooms.
Every patient is important to us, and we are doing all we can to provide care quickly and efficiently.

Cancer Antigen 125

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. Cancer Antigen 125
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

CA125 MAYO

Specimen Type:

Blood

Tube Type:

Gold top SST (serum separator tube, no anticoagulant) or Red top (no anticoagulant) tube

Collection Volume:

1.5 mL (minimum 1.25mL)

Cause for Rejection:

Gross hemolysis

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Electrochemiluminescent Immunoassay

Special Instructions:

This test cannot be used to diagnose cancer.

Lab/Phone:

330-543-8418

TAT:

1-3 days

Additional Info:

Reference range:

Females <46 U/mL

Males N/A

CPT Code:

86304

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