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IGF 1

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. IGF 1
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Test ID/Workstation :

IGF1 MAYO

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

1.5 mL(1.0 mL minimum)

Cause for Rejection:

Grossly hemolyzed

Storage:

Frozen

Availability:

Sent to Reference Laboratory

Methodology:

Liquid Chromatography-Mass Spectrometry (LC/MS)

Special Instructions:

Indicate patient's age and sex.

Lab/Phone:

330-543-8418

TAT:

2-3 days

Additional Info:

Reference range available on patient report

CPT Code:

84305

Synonyms:

Somatomedin C

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IGF 1

Centralized Core Laboratory : Chemistry

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