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. Hereditary Hemochromatosis DNA Test
2.
3.
4.
5.
6.
SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
HFET
Test Workstation :
MAYO
Specimen Type:
Whole Blood
Tube Type:
Purple top (EDTA) tube: Whole Blood
Alternate Tube Type:
ACD or any anticoagulant tube
Collection Volume:
2.5 mL (minimum 0.5 mL)
Storage:
Ambient
Availability:
Sent to Reference Laboratory
Methodology:
Droplet Digital Polymerase Chain Reaction (ddPCR) used to test for 3 mutations in the HFE gene: C282Y,H63D,S65C
Special Instructions:
Molecular Genetics: Congenital Inherited Diseases Patient Information (T521) in Special Instructions.
For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly).
Lab/Phone:
330-543-8418
TAT:
6-7 days
Additional Info:
Reference range is available on patient report
CPT Code:
81256
Hereditary Hemochromatosis DNA Test
Test ID/Workstation :
HFET
Specimen Type:
Whole Blood
Tube Type:
Purple top (EDTA) tube: Whole Blood
Collection Volume:
2.5 mL (minimum 0.5 mL)
Storage:
Ambient
Availability:
Sent to Reference Laboratory
Methodology:
Droplet Digital Polymerase Chain Reaction (ddPCR) used to test for 3 mutations in the HFE gene: C282Y,H63D,S65C
Special Instructions:
Molecular Genetics: Congenital Inherited Diseases Patient Information (T521) in Special Instructions.
For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly).
Lab/Phone:
330-543-8418
TAT:
6-7 days
Additional Info:
Reference range is available on patient report
CPT Code:
81256
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