Oligoclonal Banding

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. Oligoclonal Banding
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

OLIGA

Test Workstation :

MAYO

Specimen Type:

Blood and CSF

Tube Type:

Red top (no anticoagulant) tube and CSF container

Collection Volume:

1.5 mL (minimum 1.0 mL) serum and 0.5 mL (minimum 0.4 mL) CSF

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Isoelectric Focusing (IEF) with IgG Immunoblot Detection

Special Instructions:

Label specimen as serum. Label specimen as spinal fluid. Spinal fluid must be obtained within 1 week of serum draw.

Lab/Phone:

330-543-8418

TAT:

2-3 days

Additional Info:

Reference range available on patient report

CPT Code:

83916 x 2

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Oligoclonal Banding

Centralized Core Laboratory - Mayo Clinic Laboratories : Send Out

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