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

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

OTREE

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 Laboratory

Methodology:

Fluorescence Enzyne 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:

Sweet Gum IgE, Mountain Cedar IgE, Beech IgE, Hazelnut IgE, Elm IgE, Oak IgE, Silver Birch IgE, White Hickory IgE, Eastern Sycamore IgE, White Pine IgE, White Ash IgE, Willow IgE, Walnut IgE, Cottonwood IgE, Privet Tree IgE, Mulberry IgE, Boxelder-Maple IgE

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Ohio Trees Allergen Panel

Centralized Core Laboratory - Mayo Clinic Laboratories : Send Out

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