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.

Carotene

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. Carotene
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

CAROT MAYO

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant)

Collection Volume:

2.5 mL (minimum 1.5 mL)

Storage:

Ambient

Availability:

Sent to reference lab

Methodology:

High-Performance Liquid Chromatography (HPLC)

Special Instructions:

Send specimen in an amber vial. Protect specimen from light.

Lab/Phone:

330-543-8418

TAT:

2- 7 days

Additional Info:

Reference range: 3 - 91 ug/dL

CPT Code:

82380

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