Disaccharidase Activity Panel, Ts
| 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 | |
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| 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
