Epstein-Barr Virus (EBV), Reflex to Quantitative PCR

Molecular Diagnostics - : DNA

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 (EBV), Reflex to Quantitative PCR
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SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

LAB3991/EBVPR

Test Workstation :

DNA2

Specimen Type:

2 mL blood collected in one EDTA (purple top) tube.

Minimum Volume:

Specimen minimum volume is 0.5 mL.

Cause for Rejection:

Quantity not sufficient, specimen clotted, improper anticoagulant, improper specimen type, improper storage/transport, mislabeled, or unlabeled.

Storage:

Refrigerated

Availability:

Mon-Fri (7:30-16:00)

Methodology:

Real-time Polymerase Chain Reaction

Special Instructions:

Upon arrival in laboratory, promptly centrifuge blood specimen tube and send 1.0 mL of the plasma to the Molecular laboratory. Refrigerate.

Lab/Phone:

330-543-8722

TAT:

1-3 days

Additional Info:

If positive, Qualitative test will be cancelled and Quantitative test will be ordered and resulted.

CPT Code:

87798 if result negative: 87799 if result positive

Synonyms:

EpsteinBarr Virus DNA, EBV DNA

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Epstein-Barr Virus (EBV), Reflex to Quantitative PCR

Molecular Diagnostics - : DNA

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