Ferritin

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. Ferritin
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

FERTN E8011

Specimen Type:

Blood

Tube Type:

Green top (lithium heparin) tube

Collection Volume:

1.5 mL

Cause for Rejection:

Hemolysis

Storage:

Shipping- Send Refrigerated; Storage- Room Temp: 48 hours; Refrigerated: 7 days; Frozen: 12 months

Availability:

24 hours/day, 7 days/week

Methodology:

Roche-Electrochemiluminescence Immunoassay sandwich principle

Lab/Phone:

330-543-8417

TAT:

4 hours

Additional Info:

Ref. range is age dependent; avail on patient report

CPT Code:

82728

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