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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