HHV-6 PCR

Infectious Disease Laboratories : Virology

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. HHV-6 PCR
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

HHV6P MAYO

Specimen Type:

Blood

Tube Type:

Lavender top (EDTA) tube

Collection Volume:

2.5 mL (minimum 1.0 mL)

Cause for Rejection:

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Real-Time Polymerase Chain Reaction (PCR)/DNA Hybridization

Lab/Phone:

330-543-8418

TAT:

2-5 days

CPT Code:

87532

Synonyms:

Human Herpesvirus-6 PCR

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