IgG Subclasses

Centralized Core Laboratory - Mayo Clinic Laboratories : Send Out

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. IgG Subclasses
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

IGGSU

Test Workstation :

MAYO

Specimen Type:

Blood

Tube Type:

Red Top (no anticoagulant) tube

Collection Volume:

2.5 mL (minimum 1.5 mL)

Cause for Rejection:

Gross Hemolysis, Gross lipemia

Storage:

Refrigerated

Availability:

Sent to Reference Laboratory

Methodology:

Turbidimetry

Lab/Phone:

330-543-8418

TAT:

1-3 days

Additional Info:

Ref. range is age dependent; avail on patient report

CPT Code:

82784, 82787 x 4

Panel Includes:

Total IgG, IgG Subclass 1, IgG Subclass 2, IgG Subclass 3, and IgG Subclass 4

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IgG Subclasses

Centralized Core Laboratory - Mayo Clinic Laboratories : Send Out

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