We are experiencing exceptionally high volumes in our emergency rooms.
Every patient is important to us, and we are doing all we can to provide care quickly and efficiently.

Cystatin C

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. Cystatin C
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

CYSTC MAYO

Specimen Type:

Blood

Tube Type:

GOLD TOP (SST) TUBE

Collection Volume:

1.5 mL (minimum 1.0 mL)

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Immunoturbidimetric

Special Instructions:

Cystatin C: 18-49 years: 0.63-1.03 mg/L; > or =50 years: 0.67-1.21 mg/L; 0-17 years: Reference values have not been established. Refer to estimated glomerular filtration rate (eGFR). --- Estimated GFR: >60 mL/min/BSA; Adult eGFR: Estimated GFR calculated using CKD-EPI Cystatin C equation. Pediatric eGFR: Estimated GFR calculated using Schwartz Cystatin C equation

Lab/Phone:

330-543-8418

CPT Code:

82610

Panel Includes:

Cystatin C, Serum Estimated Glomerular Filtration Rate (eGFR) by Cystatin C

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The five differences are:
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