Centralized Core Laboratory - Mayo 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. Gabapentin
2.
3.
4.
5.
6.
SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
GABAP
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
2.5 mL (minimum 0.5 mL)
Cause for Rejection:
SST/Gold Top
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Special Instructions:
1. Draw specimen immediately before next scheduled dose.
2. Spin down within 2 hours of draw.
For Outpatients, send specimen by courier STAT to hospital lab.
Lab/Phone:
330-543-8418
TAT:
1-2 days
Additional Info:
Reference range: 2-20 ug/mL
CPT Code:
80171
Synonyms:
Neurontin
Gabapentin
Test ID/Workstation :
GABAP
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
2.5 mL (minimum 0.5 mL)
Cause for Rejection:
SST/Gold Top
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Special Instructions:
1. Draw specimen immediately before next scheduled dose.
2. Spin down within 2 hours of draw.
For Outpatients, send specimen by courier STAT to hospital lab.
Lab/Phone:
330-543-8418
TAT:
1-2 days
Additional Info:
Reference range: 2-20 ug/mL
CPT Code:
80171
Synonyms:
Neurontin
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