Mitotane

Centralized Core Laboratory : Chemistry

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. Mitotane
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Test ID/Workstation :

MIT2 MAYO

Specimen Type:

Blood

Tube Type:

Green top (sodium heparin)tube - Plasma

Collection Volume:

5.0 mL (minimum 1.0 mL)

Storage:

Refrigerated

Availability:

Sent to Reference Laboratory

Methodology:

Gas Chromatography/Flame Ionization Detection (GC-FID)

Special Instructions:

Draw blood in a green-top (sodium heparin) tube. Lab - Spin down and send sodium heparin plasma refrigerated in a plastic vial.

Lab/Phone:

330-543-8418

TAT:

5-9 days

Additional Info:

Reference range available on patient report

CPT Code:

80375

Synonyms:

Lysodren

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Mitotane

Centralized Core Laboratory : Chemistry

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