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. Coumadin
2.
3.
4.
5.
6.
SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
COUM
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Purple top (EDTA)
Collection Volume:
3.0 mL
Minimum Volume:
1.2 mL
Cause for Rejection:
Collected in a gel tube
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
High-Performance Liquid Chromatography (HPLC)
Special Instructions:
Test must be spun down within 2 hours of collection.
For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly).
Test must be spun down within 2 hours of collection.
For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly).
