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Nicotine/Cotinine

Centralized Core Laboratory : Chemistry

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. Nicotine/Cotinine
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

NICOT MAYO

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

2.0 mL (minimum 1.5 mL)

Storage:

Refrigerated

Availability:

Sent to Mayo Medical Laboratory

Methodology:

Liquid Chromatography -Tandem Mass Spectrometry (LC-MS/MS)

Special Instructions:

Days Performed: Mon-Fri

Lab/Phone:

330-543-8418

TAT:

2-4 days

Additional Info:

Reference range:

Nicotine: <3.0 ng/mL

Cotinine: <3.0 ng/mL

CPT Code:

80323

Panel Includes:

Nicotine, Cotinine

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