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. Complement, Total
2.
3.
4.
5.
6.
SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
COMPT
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
2.5 mL
Minimum Volume:
1.2 mL
Cause for Rejection:
Specimen not sent on ice, hemolysis, lipemia
Storage:
Frozen
Availability:
Sent to reference lab
Methodology:
Automated Liposome Assay
Special Instructions:
Place specimen on ice and deliver to lab promptly.
For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly).
Lab/Phone:
330-543-8418
TAT:
1-2 days
Additional Info:
Reference range: 30-75 U/mL
CPT Code:
86162
Synonyms:
CH50; Total Hemolytic Complement, Complement Deficiency Assay
Complement, Total
Test ID/Workstation :
COMPT
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
2.5 mL
Cause for Rejection:
Specimen not sent on ice, hemolysis, lipemia
Storage:
Frozen
Availability:
Sent to reference lab
Methodology:
Automated Liposome Assay
Special Instructions:
Place specimen on ice and deliver to lab promptly.
For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly).
Lab/Phone:
330-543-8418
TAT:
1-2 days
Additional Info:
Reference range: 30-75 U/mL
CPT Code:
86162
Synonyms:
CH50; Total Hemolytic Complement, Complement Deficiency Assay
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