Dilantin, Free and Total

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. Dilantin, Free and Total
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

DILFR SUMMA

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

5.0 mL (minimum 3.0 mL)

Cause for Rejection:

Storage:

Refrigerated

Availability:

Sent to reference lab daily

Methodology:

Fluorescent Polarization Immunoassay

Special Instructions:

Lab/Phone:

330-543-8418

TAT:

24 hours

Additional Info:

Reference range is available on patient report

CPT Code:

80186

Synonyms:

Phenytoin Free and Total

While we are ranked among the best children's hospitals in the country, it's our compassionate approach to treatment that makes us truly exceptional. Through a combination of revolutionary treatments and extraordinary patient experiences, our care does more than heal. It brings the entire family together for emotional support and understanding across multiple locations to reach you in the community where you live. Learn more...