Hepatitis C Quant RNA by PCR
| 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 Quant RNA by PCR | |
| 2. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
HCRNA
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Gold top SST (serum separator tube, no anticoagulant)
Collection Volume:
4.0 mL (minimum 2.0 mL)
Cause for Rejection:
Red Top Tube is NOT acceptable.
Storage:
Frozen
Availability:
Sent to reference lab
Methodology:
Real-Time PCR + TaqMan probe hybridization (Cobas AmpliPrep/Cobas TaqMan HCV Test)
Special Instructions:
Centrifuge blood collection tube and pour off serum into aliquot tube within 2 hours of blood collection. Freeze serum immediately.
Days Performed: Mon through Sat
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:
87522
