Cyclosporine
| 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 | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
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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
