We are experiencing exceptionally high volumes in our emergency rooms.
Every patient is important to us, and we are doing all we can to provide care quickly and efficiently.

Estrogens, Fractionated, Serum

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. Estrogens, Fractionated, Serum
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

ESTF MAYO

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

3.0 mL (minimum 2.0 mL)

Cause for Rejection:

Serum gel or SST tube

Storage:

Refrigerated

Availability:

Sent to Reference Laboratory

Methodology:

Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

Lab/Phone:

330-543-8418

TAT:

2-4 days

CPT Code:

82670 and 82679

Panel Includes:

Estrone (E1) and Estradiol (E2)

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