Fibroblast Culture-Mayo Clinic Sendout
| 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. Fibroblast Culture-Mayo Clinic Sendout | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
FIBR
Test Workstation :
MAYO
Specimen Type:
Skin biopsy- sterile container with standard cell culture media
Tube Type:
Fibroblast transport media (T115). (Obtain from CCL-Sendouts)
Collection Volume:
Skin section 4 mm in diameter
Cause for Rejection:
Specimen dry, not in sterile container, QNS
Storage:
Refrigerated
Availability:
Sent to Reference Laboratory
Methodology:
Cell Culture
Special Instructions:
4 mm punch skin biopsy in Fibroblast transport media (T115).
Obtain media from CCL(Sendouts). Sterile technique essential for noncontamination of specimen.
Lab/Phone:
330-543-4853
TAT:
41-42 Days
Additional Info:
Growth of cells depends largely on specimen quality.
CPT Code:
Fibroblast Culture CPT 88233 Cryopreservation of Fibroblast cells CPT 88240
Panel Includes:
Fibroblast Culture
Cryopreservation of Fibroblast cells.
Synonyms:
Skin fibroblast
