Mold IV Allergen Panel

Centralized Core Laboratory : Immunology

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. Mold IV Allergen Panel
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

MOLD MAYO

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

6.0 mL

Storage:

Refrigerated

Availability:

Sent to Mayo Medical Laboratory

Methodology:

Fluorescence Enzyne Immunoassay ( FEIA)

Lab/Phone:

330-543-8418

TAT:

1-3 days

Additional Info:

Reference range is available on patient report

CPT Code:

86003

Profile Includes:

Trichosporon Pllulans IgE, Cephalosporium Acremonium IgE, Mucor IgE, Candida Albicans IgE, Stemphyllium IgE, Trichophyton Rubrum IgE, Phoma Betae IgE, Helminthosporium IgE, Fusarium Moniliforme IgE, Curvularia Lunata IgE, Epicoccum Purpurascens IgE, Rhizopus Nigricans IgE, Alternaria Tenuis IgE, Aspergillus Fumigatus IgE, Cladosporium IgE, Penicillium IgE, Aspergillus niger, IgE

While we are ranked among the best children's hospitals in the country, it's our compassionate approach to treatment that makes us truly exceptional. Through a combination of revolutionary treatments and extraordinary patient experiences, our care does more than heal. It brings the entire family together for emotional support and understanding across multiple locations to reach you in the community where you live. Learn more...

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