Cyclosporine

Centralized Core Laboratory - : Chemistry

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. Cyclosporine
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

CYCAC

Test Workstation :

ACHM5

Specimen Type:

Blood

Tube Type:

Purple top (EDTA) tube: Whole Blood

Minimum Volume:

500 uL

Preferred Volume:

1.5 mL

Cause for Rejection:

Centrifuged; Clotted

Storage:

Shipping- Send Refrigerated; Storage-Refrigerated: 7 days; Frozen: 1 month

Availability:

7 days/week, Day Shift.

Methodology:

Enzyme Immunoassay

Special Instructions:

Specimen in lab by 12:00. Results by 16:00. Available STAT with the approval of the Medical Director.

Lab/Phone:

330-543-8418

TAT:

4 hours

Additional Info:

Reference range: 150-450 ng/mL

CPT Code:

80158

Synonyms:

Cyclosporine A; Sandimmune

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Cyclosporine

Centralized Core Laboratory - : Chemistry

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