NATP Workup

Centralized Core Laboratory : Hematology

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. NATP Workup
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

NATP NORC

Specimen Type:

Blood

Tube Type:

Purple top (EDTA) tube: Whole Blood & Red top (no anticoagulant) tube (Do NOT use Serum Separator Tubes)

Collection Volume:

14.0 mL EDTA & 6.0 mL serum - see special instructions for details

Storage:

Ambient

Availability:

Sent to reference lab

Methodology:

Platelet Antibody Screen, Platelet Associated IgG, HPA-1a (PLA1) Typing

Special Instructions:

Test should be ordered under the baby's Medical Record Number: Collection: Mother: 6mL serum, 14 mL EDTA whole blood Father: 14 mL EDTA whole blood baby: no specimen required; 2mL Cord Sera if available; 5mL EDTA if available Laboratory will notify Red Cross. Specimens can only be sent Mon-Thur unless special arrangements have been made. Lab will provide form to be completed. For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly).

Lab/Phone:

330-543-8418

TAT:

2 weeks

Additional Info:

Reference range is available on patient report

CPT Code:

86022