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:

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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Cancer Antigen 125

Centralized Core Laboratory : Chemistry

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