Diphtheria/Tetanus Toxoid IgG Ab

Infectious Disease Laboratories : Immunology

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. Diphtheria/Tetanus Toxoid IgG Ab
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

DPTET MAYO

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant)

Collection Volume:

2.5 mL (minimum 2.0 mL)

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Enzyme Immunoassay (EIA)

Lab/Phone:

330-543-8418

TAT:

1-4 days

Additional Info:

Diptheria Toxoid IgG Antibody Assay The minimum level of protective antibody in the normal population is between 0.01 and 0.1 IU/mL. The majority of vaccinated individuals should demonstrate protective levels of antibody >0.1 IU/mL. Tetanus Toxoid IgG Antibody Assay: The minimum level of protective antibody in the normal population is between 0.01 and 0.15 IU/mL. The majority of vaccinated individuals should demonstrate protective levels of antibody >0.15 IU/mL.

CPT Code:

86317 x 2