Centralized Core Laboratory - Mayo Clinic Laboratories :
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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. Clonazepam
2.
3.
4.
5.
6.
SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
CLONO
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
3.0 mL
Minimum Volume:
1.5 mL
Storage:
Refrigerated
Availability:
Sent to Reference Laboratory
Methodology:
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Special Instructions:
Draw specimen immediately before next scheduled dose(minimum 12 hours after last dose) Serum must be separated from cells within 2 hours of draw.
For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly).
Lab/Phone:
330-543-8418
TAT:
4-6 days
Additional Info:
Reference range available on patient report
CPT Code:
80346
Synonyms:
Klonopin
Rivotril
7Aminoclonazepam
Clonazepam
Test ID/Workstation :
CLONO
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
3.0 mL
Storage:
Refrigerated
Availability:
Sent to Reference Laboratory
Methodology:
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Special Instructions:
Draw specimen immediately before next scheduled dose(minimum 12 hours after last dose) Serum must be separated from cells within 2 hours of draw.
For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly).
Lab/Phone:
330-543-8418
TAT:
4-6 days
Additional Info:
Reference range available on patient report
CPT Code:
80346
Synonyms:
Klonopin
Rivotril
7Aminoclonazepam
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