Hepatitis C Ab with Reflex to PCR

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 C Ab with Reflex to PCR
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

HEPCR

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:

1.5 mL

Storage:

Shipping- Send Refrigerated; Storage-Room Temp: 3 days; Refrigerated: 21 days; Frozen: 3 months

Availability:

24 hours/day, 7 days/week

Methodology:

Roche-Electrochemiluminescence Immunoassay sandwich principle

Lab/Phone:

330-543-8418

TAT:

4 hours

Additional Info:

If Hepatitis C Virus antibody is reactive, then Hepatitis C Virus RNA will be performed at an additional charge. Serum separator tube (SST) is the only acceptable specimen type for confirmatory testing.

CPT Code:

86803

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Hepatitis C Ab with Reflex to PCR

Centralized Core Laboratory - : Chemistry

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