Hepatitis C Virus Genotype
| PATIENT INFO |
| Patient Name: |
| Medical Record #: |
| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
| Address: |
| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
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| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. Hepatitis C Virus Genotype | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
HCVG
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Serum Separator Tube (SST),Serum
Collection Volume:
12.5 mL (minimum 4.0 mL)
Cause for Rejection:
Specimen rejected: Heparinized specimen, redtop tube, or plasma
Storage:
Frozen
Availability:
Sent to reference lab
Methodology:
Reverse Transcriptase-Polymerase Chain Reaction(RT-PCR)followed by Hybridization with sequence-specific, Flourescent-labeled Olig. probes
Special Instructions:
Centrifuge blood collection tube and pour off serum within 2 hours into aliquot tube. For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Mahoning Valley)
Lab/Phone:
330-543-8418
TAT:
1-6 days
Additional Info:
Reference Range: Undetected
CPT Code:
87902
Synonyms:
HCV Genotype
