Hepatitis B Surface Ag
| PATIENT INFO |
| Patient Name: |
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| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
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| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
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| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. Hepatitis B Surface Ag | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
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Test ID :
HEPBS
Test Workstation :
E8011
Specimen Type:
Blood
Tube Type:
SST (serum separator tube,no anticoagulant)
Collection Volume:
3.0 mL (minimum 1.5 mL)
Minimum Volume:
1.5 mL
Preferred Volume:
3 mL
Storage:
Shipping- Send Refrigerated; Storage- Room Temp: 6 days; Refrigerated: 14 days; Frozen: 6 months
Availability:
24 hours/day, 7 days/week
Methodology:
Roche- Electrochemiluminescence Immunoassay sandwich principle
Special Instructions:
If confirmatory testing is required SST serum is the only acceptable specimen type. Hepatitis B Surface Antigen Confirmation will be ordered and charged on all initially reactive Hepatitis B Surface Antigen tests.
Lab/Phone:
330-543-8418
TAT:
4 hours
Additional Info:
Reference range: Negative
CPT Code:
87340
