Histamine Plasma

PATIENT INFO

Patient Name:

Medical Record #:

BD: / / Sex: F M

PHYSICIAN INFO

Physician Name :

Address:

Ph: ( ) - Fax: ( ) -

Additional Report to:

Ph: ( ) - Fax: ( ) -

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

HISTM

Test Workstation :

MAYO

Specimen Type:

plasma

Tube Type:

Purple top (EDTA)

Collection Volume:

3.0 mL (minimum 1.0 mL)

Storage:

Frozen

Availability:

Sent to Reference Laboratory

Methodology:

Enzyme Immunoassay (EIA)

Special Instructions:

Draw 3 mL blood in a lavender top (EDTA) tube(s). Cool immediately on ice. The centrifugation should be performed within 20 minutes of collection.

Lab/Phone:

330-543-8418

TAT:

2-7 days

Additional Info:

Reference range is available on patient report

CPT Code:

83088