Immunoglobulins A, G, M

Centralized Core Laboratory - : Special 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. Immunoglobulins A, G, M
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

IGGAM

Test Workstation :

SCYEL

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

1.0 mL (minimum 0.7 mL)

Cause for Rejection:

Lipemia

Storage:

Frozen

Availability:

Mon, Wed, Fri (0800-1600)

Methodology:

Nephelometry

Special Instructions:

Do not use serum separator tube. Specimen must be in lab by 1300 for same day results.

Lab/Phone:

330-543-8484

TAT:

1-3 days

Additional Info:

Reference ranges available under individual tests

CPT Code:

82784

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Immunoglobulins A, G, M

Centralized Core Laboratory - : Special Chemistry

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