Immunoglobulins A, G, M
| 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. | |
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| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
IGGAM
Test Workstation :
ACHM5
Specimen Type:
Blood
Tube Type:
Green top (lithium heparin) tube
Collection Volume:
1.0 mL
Minimum Volume:
0.7 mL
Storage:
Storage-Room Temp: 2 months; Refrigerated: 4 months; Frozen: 6 months
Availability:
24 hours/day, 7 days/week
Methodology:
Roche- Immunoturbidimetric
Lab/Phone:
330-543-8484
TAT:
4 hours
Additional Info:
Reference ranges available under individual tests
CPT Code:
82784
