Growth Hormone

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. Growth Hormone
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

GH E8011

Specimen Type:

Blood

Tube Type:

Green top (lithium heparin) tube

Collection Volume:

1.5 mL

Storage:

Shipping-Send Refrigerated; Storage-Room Temp: 8 hours; Refrigerated: 1 day; Frozen: 1 month

Availability:

24 hours/day, 7 days/week

Methodology:

Roche-ECLIA sandwich principle

Special Instructions:

Freeze plasma if unable to send to lab same day as collection

Lab/Phone:

330-543-8417

TAT:

4 hours

Additional Info:

Reference range available on patient report

CPT Code:

83003

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