Histoplasma Abs

Infectious Disease Laboratories : 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. Histoplasma Abs
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

HISTO MAYO

Specimen Type:

Blood

Tube Type:

Red Top (no anticoagulant) tube

Collection Volume:

1.5 mL

Cause for Rejection:

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Complement Fixation/Immunodiffusion (CF/ID)

Special Instructions:

Lab/Phone:

330-543-8418

TAT:

2-7 days

Additional Info:

Reference range is available on patient report

CPT Code:

86698x3

Panel Includes:

Histo Mycelial Ab-CF, Histo Yeast Ab-CF and Histoplasma Ab ID

Synonyms:

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Histoplasma Abs

Infectious Disease Laboratories : Immunology

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