Mono-Screen

Infectious Disease Laboratories - : Microbiology

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. Mono-Screen
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

MSPOT

Test Workstation :

MIC1

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

0.5 mL

Cause for Rejection:

Any anticoagulant other than EDTA or heparin

Storage:

Refrigerated

Availability:

Daily

Methodology:

Immunochromatography for heterophile antibody

Special Instructions:

May be collected by fingerstick or venipuncture. Specimen types: Blood serum(red top), plasma(heparin) or whole blood(EDTA). Serum is preferred specimen.

Lab/Phone:

330-543-8412

TAT:

1-24 hours

Additional Info:

Reference range: Negative

CPT Code:

86308

Synonyms:

Mono Test

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Mono-Screen

Infectious Disease Laboratories - : Microbiology

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