We are experiencing exceptionally high volumes in our emergency rooms.
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Hepatitis B Surface Ag

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. Hepatitis B Surface Ag
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

HEPBS E8011

Specimen Type:

Blood

Tube Type:

Gold top SST (serum separator tube, no anticoagulant)

Collection Volume:

3.0 mL (minimum 1.5 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:

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

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