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. Lacosamide, Serum
2.
3.
4.
5.
6.
SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
LACOS
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
2.5 mL minimum 0.5 mL
Storage:
Refrigerated
Availability:
Sent to Reference Laboratory
Methodology:
Liquid Chromatgraphy-Tandem Mass Spectrometry (LC-MS/MS)
Special Instructions:
1. Draw blood immediately before next scheduled dose.
2. For sustainedrelease formulations ONLY, draw blood a minimum of 12 hours after last dose.
3. Centrifuge and aliquot serum into plastic vial within 2 hours of collection.
Lab/Phone:
330-543-8418
TAT:
1-4 days
Additional Info:
Reference Range:
1.0-10.0 mcg/mL
CPT Code:
80235
Lacosamide, Serum
Test ID/Workstation :
LACOS
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
2.5 mL minimum 0.5 mL
Storage:
Refrigerated
Availability:
Sent to Reference Laboratory
Methodology:
Liquid Chromatgraphy-Tandem Mass Spectrometry (LC-MS/MS)
Special Instructions:
1. Draw blood immediately before next scheduled dose.
2. For sustainedrelease formulations ONLY, draw blood a minimum of 12 hours after last dose.
3. Centrifuge and aliquot serum into plastic vial within 2 hours of collection.
Lab/Phone:
330-543-8418
TAT:
1-4 days
Additional Info:
Reference Range:
1.0-10.0 mcg/mL
CPT Code:
80235
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There are 10 nurses in the picture.
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The five differences are:
– Phone color
– Coat pocket
– Stethoscope earpiece color
– Stethoscope bell dot
– Clipboard paper color
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The two matching doctors are 9 and 14.
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The correct path:
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