First Trimester Screening

Centralized Core Laboratory : Special 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. First Trimester Screening
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

FIRSC GENZY

Specimen Type:

Blood

Tube Type:

Gold top SST (serum separator tube, no anticoagulant)

Collection Volume:

7.5 mL (minimum 2.5 mL)

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Chemiluminescence

Special Instructions:

Lab/Phone:

330-543-8418

TAT:

2-3 Days

Additional Info:

Reference range: Negative

CPT Code:

84163, 84702

Synonyms:

While we are ranked among the best children's hospitals in the country, it's our compassionate approach to treatment that makes us truly exceptional. Through a combination of revolutionary treatments and extraordinary patient experiences, our care does more than heal. It brings the entire family together for emotional support and understanding across multiple locations to reach you in the community where you live. Learn more...