Factor V Leiden and Factor II Prothrombin Panel, DNA Assay

Molecular Diagnostics - : DNA

PATIENT INFO

Patient Name:

Medical Record #:

BD: / / Sex: F M

PHYSICIAN INFO

Physician Name :

Address:

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Additional Report to:

Ph: ( ) - Fax: ( ) -

TESTS REQUESTED
Test Name:	ICD9 Code: (required)
1. Factor V Leiden and Factor II Prothrombin Panel, DNA Assay
2.
3.
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5.
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SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

LAB4648/TVDNZ

Test Workstation :

DNA1

Specimen Type:

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

Minimum Volume:

Specimen minimum volume is 0.6 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:

If drawing >1 Thrombophilia test only 1 EDTA tube of blood is required.

Lab/Phone:

330-543-8722

TAT:

7 days

CPT Code:

81241, 81240

Panel Includes:

Factor V Leiden, Prothrombin 20210G>A

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Factor V Leiden and Factor II Prothrombin Panel, DNA Assay

Molecular Diagnostics - : DNA

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