We are experiencing exceptionally high volumes in our emergency rooms.
Every patient is important to us, and we are doing all we can to provide care quickly and efficiently.

Histamine Plasma

Centralized Core Laboratory : Chemistry

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. Histamine Plasma
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

HISTM 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.

Lab/Phone:

330-543-8418

TAT:

2-11 days

Additional Info:

Reference Values: <1.0 ng/mL

CPT Code:

83088

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