Chloride, CSF

Centralized Core Laboratory - Mayo Clinic Laboratories : Send Out

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. Chloride, CSF
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

ZMSO,

Test Workstation :

MAYO

Specimen Type:

CSF

Tube Type:

CSF sterile container

Collection Volume:

1.0 mL (minimum 0.25 mL)

Cause for Rejection:

Gross hemolysis

Storage:

Refrigerated

Availability:

Sent to reference lab, MAYO

Methodology:

Indirect Ion-Selective Electrode (ISE)

Special Instructions:

Please order ZMSO send to Mayo

Lab/Phone:

330-543-8417

TAT:

1-2 days

Additional Info:

Mayo Reference Range: 120-130 mmol/L

CPT Code:

82438

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Chloride, CSF

Centralized Core Laboratory - Mayo Clinic Laboratories : Send Out

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