D-Dimer Quantitative
| 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. D-Dimer Quantitative | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Specimen Type:
Blood
Tube Type:
Lt. Blue Sodium Citrate
Collection Volume:
Must use appropriate sodium citrate tube based on volume of blood drawn (1.8 mL or 2.7 mL tube). Tube must be filled to the fill line.
Minimum Volume:
1.8 mL using appropriate 1.8 mL tube
Preferred Volume:
2.7 mL using appropriate 2.7 mL tube
Storage:
Ambient
Special Instructions:
Please indicate if the patient is currently receiving anticoagulant therapy. Samples should be transported to the lab as whole blood. For outpatients, send by courier STAT to the Mahoning Valley Campus.
Lab/Phone:
330-743-8416
TAT:
4 hours
CPT Code:
85379
Synonyms:
Fibrin Degradation Products, DDIMR
