NATP Workup
| 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 :
NATP
Test Workstation :
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 MonThur 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
