EBV (VCA) IgM 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. EBV (VCA) IgM Ab
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

EBVIM Mayo

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

2.5 mL (minimum 1.5 mL)

Cause for Rejection:

Grossly hemolyzed, lipemic or Icteric, contaminated specimen, drawn in incorrect tube, QNS.

Storage:

Refrigerated

Availability:

Sent to Reference Laboratory

Methodology:

Multiplex

Lab/Phone:

330-543-8576

TAT:

1-2 days

Additional Info:

Reference range: Negative

CPT Code:

86665

Synonyms:

EBV-IFA; EBV-IgM; EB or EBV Virus Titers; VCA Titer

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