We are experiencing exceptionally high volumes in our emergency rooms.
Every patient is important to us, and we are doing all we can to provide care quickly and efficiently.

Itraconazole

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. Itraconazole
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

ITRAC CLEVE

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

1.5 mL (minimum 0.5 mL)

Cause for Rejection:

Reject if drawn in SST

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

Lab/Phone:

330-543-8418

TAT:

1-4 days

Additional Info:

Reference range available on patient report

CPT Code:

80189

Panel Includes:

Itraconazole Level and Hydroxyitraconazole Level

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