Neurotransmitter Profile, CSF

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. Neurotransmitter Profile, CSF
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

NTCSF

Test Workstation :

MAYO

Specimen Type:

CSF

Tube Type:

Medical Neurogenetics collection kit required.

Collection Volume:

Collect 4.5 mL CSF.

Storage:

Frozen

Availability:

Sent to Reference Laboratory

Methodology:

High Performance Liquid Chromatography-Electrochemistry & Fluorescences

Special Instructions:

Fill each tube in collection kit to the marked line with required volumes Tube #1: 0.5 mL, Tubes #2#5:1.0 mL each; leave tube # visible.

Lab/Phone:

330-543-8418

TAT:

14-18 Days

Additional Info:

Reference range available on patient report

CPT Code:

82542 (x3), 83150, 83497

Panel Includes:

Panel includes: 5-Methyltetrahydrofolate, 5-Hydroxyindoleacetic acid, Homovanillic acid, 3-O-methlydopa, Tetrahydrobiopterin, and Neopterin

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Neurotransmitter Profile, CSF

Centralized Core Laboratory - Mayo Clinic Laboratories : Send Out

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