Leukemia Surface Markers
| 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. Leukemia Surface Markers | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
LKMKR
Test Workstation :
SUMMA
Specimen Type:
Whole Blood, bone marrow, or cellular body fluid
Tube Type:
Purple top (EDTA) tube: Whole Blood
Collection Volume:
4.0 mL
Minimum Volume:
1.0 mL
Storage:
Ambient
Availability:
Sent to reference lab
Methodology:
Flow Cytometry
Special Instructions:
For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly)
Lab/Phone:
330-543-8418
TAT:
24 hours
Additional Info:
Reference ranges are available on patient report
CPT Code:
88180
Synonyms:
Leukemia Flow Cytometry Profile
