Centralized Core Laboratory - Mayo Clinic Laboratories :
Send Out
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 Viral DNA, Ultra Quant
2.
3.
4.
5.
6.
SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
HEPUQ
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Gold top SST (Serum Separator) tube
Collection Volume:
4.0 mL (minimum 2.0mL)
Cause for Rejection:
Red Top Tube is NOT acceptable.
Storage:
Frozen
Availability:
Sent to reference lab.
Methodology:
Real-Time Polymerase Chain Reaction (PCR)
Special Instructions:
Spin down and pour off serum into aliquot tube within 2 hours of blood collection. Freeze immediately. For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Mahoning Valley)
Lab/Phone:
330-543-8418
TAT:
1-3 days
Additional Info:
Reference range: Undetected
CPT Code:
87517
Hepatitis B Viral DNA, Ultra Quant
Test ID/Workstation :
HEPUQ
Specimen Type:
Blood
Tube Type:
Gold top SST (Serum Separator) tube
Collection Volume:
4.0 mL (minimum 2.0mL)
Cause for Rejection:
Red Top Tube is NOT acceptable.
Storage:
Frozen
Availability:
Sent to reference lab.
Methodology:
Real-Time Polymerase Chain Reaction (PCR)
Special Instructions:
Spin down and pour off serum into aliquot tube within 2 hours of blood collection. Freeze immediately. For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Mahoning Valley)
Lab/Phone:
330-543-8418
TAT:
1-3 days
Additional Info:
Reference range: Undetected
CPT Code:
87517
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