Folate

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. Folate
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

FOLAT E8011

Specimen Type:

Blood

Tube Type:

Gold top SST (serum separator tube, no anticoagulant)

Collection Volume:

1.5 mL

Cause for Rejection:

Hemolysis

Storage:

Shipping- Send Refrigerated; Storage-Room Temp: 2 hours; Refrigerated: 48 hours; Frozen: 1 month

Availability:

24 hours/day, 7 days/week

Methodology:

Roche-ECLIA Competition principle

Lab/Phone:

330-543-8418

TAT:

4 hours

Additional Info:

Reference Interval:

> or = 4.8 ng/mL

CPT Code:

82746

Synonyms:

Folic Acid

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