Erythropoietin
| PATIENT INFO |
| Patient Name: |
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| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
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| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
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| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. Erythropoietin | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
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Test ID :
EPO
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant)tube
Collection Volume:
1.5 mL
Minimum Volume:
1.25 mL
Cause for Rejection:
Gross hemolysis
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Immunoenzymatic Assay
Lab/Phone:
330-543-8418
TAT:
1-3 days
Additional Info:
Reference range: 2.6-18.5 mIU/mL
CPT Code:
82668
