Leukemia Surface Markers

Centralized Core Laboratory - Summa Akron City Hospital : 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. 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

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Leukemia Surface Markers

Centralized Core Laboratory - Summa Akron City Hospital : Send Out

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