Centralized Core Laboratory - Mayo Clinic Laboratories :
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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. Pancreatic Elastase Panel
2.
3.
4.
5.
6.
SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
PELAS
Test Workstation :
MAYO
Specimen Type:
Stool
Tube Type:
Stool container
Collection Volume:
5 grams (minimum 1 gm) stool
Storage:
Frozen
Availability:
Sent to reference lab
Methodology:
Enzyme-Linked Immunosorbent Assay (ELISA)
Special Instructions:
Collect 5 grams random formed stool, ship frozen if greater than 72 hours. Separate specimens must be submitted when multiple tests are ordered.
Note: Consistency of raw fecal sample may affect analytical performance.
Lab/Phone:
330-543-8418
TAT:
3-5 days
Additional Info:
Reference Values:
Normal = >200 ug Elastase/g stool
Moderate Pancreatic Insufficiency = 100 - 200 ug Elastase/g stool
Severe pancreatic insufficiency = <100 ug Elastase/g stool
Reference values apply to all ages.
CPT Code:
82653
Pancreatic Elastase Panel
Test ID/Workstation :
PELAS
Specimen Type:
Stool
Tube Type:
Stool container
Collection Volume:
5 grams (minimum 1 gm) stool
Storage:
Frozen
Availability:
Sent to reference lab
Methodology:
Enzyme-Linked Immunosorbent Assay (ELISA)
Special Instructions:
Collect 5 grams random formed stool, ship frozen if greater than 72 hours. Separate specimens must be submitted when multiple tests are ordered.
Note: Consistency of raw fecal sample may affect analytical performance.
Lab/Phone:
330-543-8418
TAT:
3-5 days
Additional Info:
Reference Values:
Normal = >200 ug Elastase/g stool
Moderate Pancreatic Insufficiency = 100 - 200 ug Elastase/g stool
Severe pancreatic insufficiency = <100 ug Elastase/g stool
Reference values apply to all ages.
CPT Code:
82653
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