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.

Leptin

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. Leptin
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

LEP MAYO

Specimen Type:

Blood

Tube Type:

Plain Red top (no anticoagulant) tube

Collection Volume:

2.5 mL (minimum 1.5 mL)

Storage:

Frozen

Availability:

Sent to reference lab

Methodology:

Enzyme-Linked Immunoabsorbant Assay(ELISA)

Special Instructions:

Lab: Spin down and send serum frozen in a plastic vial.

Lab/Phone:

330-543-8418

TAT:

2 - 6 days

Additional Info:

Reference available on patient report

CPT Code:

83520

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