Estradiol

Centralized Core Laboratory : Chemistry

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. Estradiol
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

ESTA E8011

Specimen Type:

Blood

Tube Type:

Green top (lithium heparin) tube

Collection Volume:

1.5 mL

Storage:

Shipping- Send Refrigerated; Storage-Room Temp: 24 hours; Refrigerated: 2 days; Frozen: 6 months

Availability:

Sent to reference lab

Methodology:

Roche-ECLIA Competition principle

Lab/Phone:

330-543-8418

TAT:

4 hours

Additional Info:

Reference range available on patient report

CPT Code:

82670

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