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Cytogenomic Microarray Analysis of Postnatal Blood
Cytogenetics Laboratory :
Cytogenetics
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. Cytogenomic Microarray Analysis of Postnatal Blood
2.
3.
4.
5.
6.
SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID/Workstation :
MCRY1 / CYTO
Specimen Type:
Blood
Tube Type:
Purple (EDTA) tube AND Green top (Sodium heparin) tube; Whole blood
Collection Volume:
3.0 mL (minimum 2.0 mL) purple top (EDTA) and 2.0 mL (minimum 1.0 mL) Green top (Sodium heparin) tubes
Storage:
Ambient
Methodology:
Chromosomal Microarray (CMA) Using Affymetrix Cytoscan DX
Special Instructions:
Must collect both Purple (EDTA) and Green (sodium heparin) tubes
Lab/Phone:
330-543-8483
TAT:
~4 weeks
CPT Code:
81229
Cytogenomic Microarray Analysis of Postnatal Blood
Test ID/Workstation :
MCRY1 / CYTO
Specimen Type:
Blood
Tube Type:
Purple (EDTA) tube AND Green top (Sodium heparin) tube; Whole blood
Collection Volume:
3.0 mL (minimum 2.0 mL) purple top (EDTA) and 2.0 mL (minimum 1.0 mL) Green top (Sodium heparin) tubes
Storage:
Ambient
Methodology:
Chromosomal Microarray (CMA) Using Affymetrix Cytoscan DX
Special Instructions:
Must collect both Purple (EDTA) and Green (sodium heparin) tubes
Lab/Phone:
330-543-8483
TAT:
~4 weeks
CPT Code:
81229
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