Clonidine
| 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. Clonidine | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
CLNID
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Alternate Tube Type:
Green top (Sodium Heparin) tube
Collection Volume:
10 mL
Minimum Volume:
3.0 mL
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Liquid Chromatography/Tandem Mass Spectrometry (LCMS)
Special Instructions:
Spin down and send 5.0 mL serum or plasma in a plastic vial.
Lab/Phone:
330-543-8418
TAT:
5-7 days
Additional Info:
Reference range: 1.00-2.00 ng/mL
CPT Code:
80375
Synonyms:
Catapres
