Centralized Core Laboratory - Mayo Clinic Laboratories :
Send Out
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. Disaccharidase Activity Panel, Ts
2.
3.
4.
5.
6.
SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
DISAT
Test Workstation :
MAYO
Specimen Type:
Tissue
Tube Type:
Clean screw top plastic vial
Collection Volume:
5 mg tissue
Cause for Rejection:
Specimens sent in formaldehyde, saline, or any supportive media
Gauze
Filter paper
Foil
Swabs
Storage:
Frozen
Methodology:
Spectrophotometry
Special Instructions:
Freeze immediately after collection and ship frozen.
Note:Specimen should not be placed on gauze, filter paper, nor should any saline, support or embedding material be added.
Lab/Phone:
330-543-8418
TAT:
3-5 days
Additional Info:
Reference Values
Lactase: > or =14.0 nmol/min/mg protein
Sucrase: > or =19.0 nmol/min/mg protein
Maltase: > or =70.0 nmol/min/mg protein
Palatinase: > or =6.0 nmol/min/mg protein
Glucoamylase: > or =8.0 nmol/min/mg protein
CPT Code:
82657
Disaccharidase Activity Panel, Ts
Test ID/Workstation :
DISAT
Specimen Type:
Tissue
Tube Type:
Clean screw top plastic vial
Collection Volume:
5 mg tissue
Cause for Rejection:
Specimens sent in formaldehyde, saline, or any supportive media
Gauze
Filter paper
Foil
Swabs
Storage:
Frozen
Methodology:
Spectrophotometry
Special Instructions:
Freeze immediately after collection and ship frozen.
Note:Specimen should not be placed on gauze, filter paper, nor should any saline, support or embedding material be added.
Lab/Phone:
330-543-8418
TAT:
3-5 days
Additional Info:
Reference Values
Lactase: > or =14.0 nmol/min/mg protein
Sucrase: > or =19.0 nmol/min/mg protein
Maltase: > or =70.0 nmol/min/mg protein
Palatinase: > or =6.0 nmol/min/mg protein
Glucoamylase: > or =8.0 nmol/min/mg protein
CPT Code:
82657
By using this site, you consent to our use of cookies. To learn more, read our
privacy policy.
