Pancreatic Enzyme Panel

Centralized Core Laboratory : Chemistry

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 Enzyme Panel
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Test ID/Workstation :

PEP JOLI

Specimen Type:

Duodenal Fluid

Tube Type:

Fluid container

Collection Volume:

1.0 mL (minimum 0.5 mL)

Cause for Rejection:

Storage:

Frozen

Availability:

Sent to reference lab

Methodology:

See individual tests

Special Instructions:

Check pH of fluid to make sure the pH is 6.5 or higher.

Lab/Phone:

330-543-8418

TAT:

5 days

Additional Info:

Reference range is available on patient report

CPT Code:

83519

Panel Includes:

pH, Trypsin, Amylase, Lipase, Chymotrypsin, Protein

Synonyms:

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Pancreatic Enzyme Panel

Centralized Core Laboratory : Chemistry

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