Herpes Simplex Virus Type 1 and 2 Specific Antibodies, Serum

Infectious Disease Laboratories : Virology

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. Herpes Simplex Virus Type 1 and 2 Specific Antibodies, Serum
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Test ID/Workstation :

HSVSP/MAYO

Specimen Type:

Blood, Serum

Tube Type:

Serum Separator Tube (SST)

Collection Volume:

2.5 mL (minimum 2.0 mL)

Cause for Rejection:

Grossly Hemolyzed or Grossly Lipemic.

Storage:

Refrigerated

Availability:

Sent to Reference Lab Monday - Saturday

Methodology:

Multiplex Immunoassay (MFI) Enzyme Immunoassay (EIA) Immunoflourescence Assay (IFA)

Lab/Phone:

330-543-8418

TAT:

1-2 days

CPT Code:

86694, 86695, 86696, and if reflexed 86694

Panel Includes:

HSV Ab Screen, IgM, S by EIA HSV, Type 1 Ab, IgG, S HSV Type 2 Ab, IgG, S Reflex test if needed HSV Ab, IgM, S by IFA

Synonyms:

gG-1 gG-2 Herpes Simplex Antibodies, IgG & IgM Herpes Simplex Serology Herpes Simplex Virus Antibody HSV Ab HSV Glycoprotein 1 & 2 HSV IgM and IgG Panel

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Herpes Simplex Virus Type 1 and 2 Specific Antibodies, Serum

Infectious Disease Laboratories : Virology

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