Ohio Grasses Allergen Panel

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. Ohio Grasses Allergen Panel
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

OGRAS

Test Workstation :

MAYO

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

6.0 mL

Minimum Volume:

5.0 mL

Storage:

Refrigerated

Availability:

Sent to Mayo Medical Laboratories

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:

Short Ragweed IgE, Russian Thistle IgE, Lamb's Quarters IgE, Mugwort IgE, Giant Ragweed IgE, English Plantain IgE, Rough Pigweed IgE, Nettle IgE, Firebush IgE, Red Sorrel IgE, Cocklebur IgE, Timothy Grass IgE, Bermuda Grass IgE, Johnson Grass IgE, Ry Grass IgE, Sweet Vernal Grass IgE

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Ohio Grasses Allergen Panel

Centralized Core Laboratory - Mayo Clinic Laboratories : Send Out

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