Fluoxetine/Norfluoxetine

Centralized Core Laboratory - Cleveland Clinic Laboratories : Send Out

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. Fluoxetine/Norfluoxetine
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

FLUOX

Test Workstation :

CLEVE

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Alternate Tube Type:

EDTA- Lav

Collection Volume:

7.5 mL

Minimum Volume:

3.0 mL

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Gas Chromatography Mass Spectrometry (GCMS)

Special Instructions:

Do not use serum separator tube. Separate serum from cells within 2 hours of collection. For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly)

Lab/Phone:

330-543-8418

TAT:

6-9 days

CPT Code:

G0480, 80332

Synonyms:

Prozac

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Fluoxetine/Norfluoxetine

Centralized Core Laboratory - Cleveland Clinic Laboratories : Send Out

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