Non-Seasonal Inhalant Allergen Profile

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. Non-Seasonal Inhalant Allergen Profile
2.
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5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

NSIP

Test Workstation :

MAYO

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant)tube

Collection Volume:

3.0 mL

Minimum Volume:

2.5 ml

Storage:

Refrigerated

Availability:

Sento to Mayo Medical Laboratory

Methodology:

Fluorescence Enzyme Immunoassay (FEIA)

Lab/Phone:

330-543-8418

TAT:

1-3 days

Additional Info:

Reference range is available on patient report

CPT Code:

86003

Panel Includes:

Cat epithelium IgE, Dog Dander IgE, Penicillium Chrysogenum IgE, A. fumigatas IgE, Alternaria tenuis IgE, Cladosporium IgE, House Dust/Greer Lab IgE, House Dust/H-S Lab IgE, House Dust Mites/D. pteronyssinus, House Dust Mites/D. farinae

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Non-Seasonal Inhalant Allergen Profile

Centralized Core Laboratory - Mayo Clinic Laboratories : Send Out

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