Lamotrigine

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. Lamotrigine
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

LAMOT

Test Workstation :

MAYO

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

2.5 mL (minimum 1.5 mL)

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Liquid Chromatography-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 within 2 hours of collection

Lab/Phone:

330-543-8418

TAT:

1-2 days

Additional Info:

Reference Range available on patient report

CPT Code:

80175

Synonyms:

Lamictal

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Lamotrigine

Centralized Core Laboratory - Mayo Clinic Laboratories : Send Out

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