Histone IgG Antibody

- : Immunology

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. Histone IgG Antibody
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

HISAB

Test Workstation :

CLEVE

Specimen Type:

Blood

Tube Type:

Gold top SST (serum separator tube, no anticoagulant)

Collection Volume:

2.5 mL (minimum 1.5 mL)

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Enzyme- Linked Immunosorbent Assay (ELISA)

Special Instructions:

Days Performed: Thursday

Lab/Phone:

330-543-8418

TAT:

1-8 days

Additional Info:

Reference range:

Negative: < 1 Unit

Weak Positive: 1.0-1.5 Units

Moderate Positive: 1.6-2.5 Units

Strong Positive: >2.5 Units

CPT Code:

86235

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Histone IgG Antibody

- : Immunology

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