Epstein-Barr Virus Antibody Profile
| 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. Epstein-Barr Virus Antibody Profile | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Specimens received in the Virology Laboratory before 1:00 PM will be run on the same day.
EBV IgM -
The method for qualitative determination of specific IgM to EBV viral capsid antigen (VCA).
EBNA IgG -
The method for qualitative determination of specific IgG to EBV nuclear antigen (EBNA).
VCA IgG -
The method for qualitative determination of specific IgG to EBV viral capsid antigen (VCA).

