Lyme Disease PCR

Centralized Core Laboratory - Mayo 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. Lyme Disease PCR
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

LYMPC

Test Workstation :

MAYO

Specimen Type:

Whole Blood

Tube Type:

Purple top (EDTA) tube

Collection Volume:

1.0 mL (minimum 0.3 mL)

Cause for Rejection:

Anticoagulants other than EDTA

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Real-Time Polymerase Chain Reaction (PCR)/DNA Probe Hybridization

Lab/Phone:

330-543-8418

TAT:

1-4 days

CPT Code:

87476, 87798x2

Panel Includes:

Borrelia burgdorferi PCR Borrelia mayonii PCR Borrelia garinii PCR Borrelia afzelli PCR

Synonyms:

Borrelia burgdorferi PCR Borrelia mayonii PCR Borrelia garinii PCR Borrelia afzelli PCR

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Lyme Disease PCR

Centralized Core Laboratory - Mayo Clinic Laboratories : Send Out

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