HIV-1 Genotype
| 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. HIV-1 Genotype | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
HVGEN
Test Workstation :
MAYO
Specimen Type:
Plasma
Tube Type:
Purple top (EDTA) tube
Collection Volume:
6.0 mL (minimum 3.0 mL)
Cause for Rejection:
Drawn in Greentop (heparin) tube
Storage:
Frozen
Availability:
Sent to Reference Laboratory
Methodology:
Reverse Transcription Polymerase Chain Reaction (RT-PCR) followed by Targeted Next-Generation Sequencing (NGS)
Special Instructions:
Centrifuge and separate plasma from cells within 2 hours of collection.
If collected at an offsite location, send by a STAT Courier to Hospital lab
Specimens submitted for HIV1 genotyping must contain 1000 copies/mL or more of HIV1 RNA.
Lab/Phone:
330-543-8418
TAT:
3-10 days
Additional Info:
CPT Code:
0219U
