Lipoprotein Electrophoresis

Centralized Core Laboratory - Cleveland 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. Lipoprotein Electrophoresis
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SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

LIPEL

Test Workstation :

CLEVE

Specimen Type:

Blood

Tube Type:

Gold top SST (serum separator tube, no anticoagulant)

Alternate Tube Type:

Red Top Serum

Collection Volume:

2.5 mL

Minimum Volume:

1.5 mL

Cause for Rejection:

Heparin, body fluids, and frozen samples

Storage:

Ambient- after separation from cells:1 day; Refrigerated-after separation from cells: 7 days; Frozen: Unacceptable

Availability:

Sent to reference lab

Methodology:

Electrophoresis, Enzymatic, Detergent solubilization

Special Instructions:

Patient should fast for 1215 hours. If lipid results are not provided, lipid profile will be ordered and charged separately. Results for total cholesterol, triglycerides, LDL, VLDL, and HDL may be included on requisition.

Lab/Phone:

330-543-8418

TAT:

2-9 days

Additional Info:

Reference range is available on patient report

Days Performed: Thur

CPT Code:

83700, 80061

Panel Includes:

Cholesterol; Triglycerides; HDL Cholesterol; LDL Cholesterol; VLDL Cholesterol(calculated); Appearance; Lipoprotein Electrophoresis

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Lipoprotein Electrophoresis

Centralized Core Laboratory - Cleveland Clinic Laboratories : Send Out

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