Gliadin Deamidated Abs

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. Gliadin Deamidated Abs
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

GLIDA / MAYO

Specimen Type:

Blood

Tube Type:

Serum Red Top is preferred; SST(Serum Gel)tube also acceptable

Collection Volume:

1.5 mL (minimum 1.0 mL)

Cause for Rejection:

specimen grossly hemolyzed specimen grossly lipemic

Storage:

Refrigerated

Availability:

Sent to Reference Laboratory

Methodology:

Enzyme-Linked Immunosorbent Assay (ELISA)

Lab/Phone:

330-543-8377

TAT:

1-3 days

CPT Code:

83516 x 2

Panel Includes:

Gliadin Deamidated IgG Gliadin Deamidated IgA

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