Centralized Core Laboratory - Mayo Clinic Laboratories :
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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. Levetiracetam
2.
3.
4.
5.
6.
SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
LEVET
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Red top (no additive)
Collection Volume:
2.5 mL (minimum 1.5mL)
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Special Instructions:
Serum should be separated from cells within 2 hours. Draw immediately before next scheduled dose. For sustainedrelease formulations ONLY, draw blood a minimum 12 hours after last dose.
For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly).
Lab/Phone:
330-543-8418
TAT:
1-2 days
Additional Info:
Reference Range: 10.0-40.0 mcg/mL
CPT Code:
80177
Synonyms:
Keppra
Levetiracetam
Test ID/Workstation :
LEVET
Specimen Type:
Blood
Tube Type:
Red top (no additive)
Collection Volume:
2.5 mL (minimum 1.5mL)
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Special Instructions:
Serum should be separated from cells within 2 hours. Draw immediately before next scheduled dose. For sustainedrelease formulations ONLY, draw blood a minimum 12 hours after last dose.
For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly).
Lab/Phone:
330-543-8418
TAT:
1-2 days
Additional Info:
Reference Range: 10.0-40.0 mcg/mL
CPT Code:
80177
Synonyms:
Keppra
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