Lacosamide, Serum

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. Lacosamide, Serum
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

LACOS MAYO

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

2.5 mL minimum 0.5 mL

Storage:

Refrigerated

Methodology:

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

Lab/Phone:

330-543-8418

TAT:

1-4 days

Additional Info:

Reference Range: 1.0-10.0 mcg/mL

CPT Code:

80299

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