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. Imipram/Desipramine
2.
3.
4.
5.
6.
SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
IMIDP
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
2.5 mL
Minimum Volume:
0.75 mL
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Special Instructions:
Collect immediately prior to next dose. Serum must be separated from cells within 2 hours of collection.
For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Mahoning Valley)
Lab/Phone:
330-543-8418
TAT:
3-5 days
Additional Info:
Reference range:
Desipramine Critical Value: greater than 400 ng/mL
Total Therapeutic Concentration Imip/Desipramine: 175-300 ng/mL
CPT Code:
80335, G0480 (if appropriate)
Panel Includes:
Imipramine; Desipramine; Total Imipramine/Desipramine
Imipram/Desipramine
Test ID/Workstation :
IMIDP
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
2.5 mL
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Special Instructions:
Collect immediately prior to next dose. Serum must be separated from cells within 2 hours of collection.
For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Mahoning Valley)
Lab/Phone:
330-543-8418
TAT:
3-5 days
Additional Info:
Reference range:
Desipramine Critical Value: greater than 400 ng/mL
