Myelin Basic Protein CSF
| 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. Myelin Basic Protein CSF | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
MBP
Test Workstation :
CLEVE
Specimen Type:
CSF
Tube Type:
CSF container
Collection Volume:
1.0 mL
Minimum Volume:
0.3 mL
Storage:
Frozen
Availability:
Sent to reference lab
Methodology:
Enzyme Linked Immunoassay (ELISA)
Special Instructions:
If CSF is bloody, centrifuge the sample and separate supernatant from cells prior to freezing.
Lab/Phone:
330-543-8418
TAT:
2-5 days
Additional Info:
Reference range: 0.00-5.50 ng/mL
Days Performed: Mon, Wed, Fri
CPT Code:
83873
