NMO/AQP4 FACS, Serum

Centralized Core Laboratory - Mayo Clinic Laboratories : Send Out

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. NMO/AQP4 FACS, Serum
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

NMOFS

Test Workstation :

MAYO

Specimen Type:

Blood - Serum

Tube Type:

Red Top Tube (no anticoagulant)

Collection Volume:

7.5mL (minimum 5.0mL)

Storage:

Refrigerated

Availability:

Sent to Reference Laboratory

Methodology:

Flow Cytometry

Lab/Phone:

330-543-8418

TAT:

5-8 days

Additional Info:

Reference range available on patient report

CPT Code:

86053 and if reflexed 86053- titer

Panel Includes:

Reflex test is NMO/AQP4 FACS Titer, Serum

Synonyms:

AQP, AQP4, Aquaporin, Devic's Antibody, NMO(Neuromyelitis Optica), NMOIgG, Optic Neuritis Antibody

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NMO/AQP4 FACS, Serum

Centralized Core Laboratory - Mayo Clinic Laboratories : Send Out

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