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. Oligosaccharide Screen, Urine
2.
3.
4.
5.
6.
SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
OLIGU
Test Workstation :
MAYO
Specimen Type:
Urine
Tube Type:
Urine container
Collection Volume:
Adult 8.0 mL random urine (minimum 2.5 mL)
Pediatric 3.0 mL random urine (minimum 2.5 mL)
Storage:
Frozen
Availability:
Sent to reference lab
Methodology:
Matrix-Assisted Laser Desorption Ionization Time-of-Flight (MALDI-TOF) Mass Spectrometry
Special Instructions:
Collect a random urine specimen. No preservative. Immediately freeze specimen.
Patient's age is required. Include family history, clinical condition (asymptomatic or acute episode), diet, and drug therapy information.
Lab/Phone:
330-543-8418
TAT:
8-15 days
Additional Info:
Reference range is available on patient report
CPT Code:
84377
Oligosaccharide Screen, Urine
Test ID/Workstation :
OLIGU
Specimen Type:
Urine
Tube Type:
Urine container
Collection Volume:
Adult 8.0 mL random urine (minimum 2.5 mL)
Pediatric 3.0 mL random urine (minimum 2.5 mL)
Storage:
Frozen
Availability:
Sent to reference lab
Methodology:
Matrix-Assisted Laser Desorption Ionization Time-of-Flight (MALDI-TOF) Mass Spectrometry
Special Instructions:
Collect a random urine specimen. No preservative. Immediately freeze specimen.
Patient's age is required. Include family history, clinical condition (asymptomatic or acute episode), diet, and drug therapy information.
Lab/Phone:
330-543-8418
TAT:
8-15 days
Additional Info:
Reference range is available on patient report
CPT Code:
84377
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