Post-Transplant Engraftment (Chimerism), DNA Assay
Molecular Diagnostics - :
DNA
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. Post-Transplant Engraftment (Chimerism), DNA Assay
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SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
LAB4801
Specimen Type:
Blood Bone Marrow
Collection Volume:
Blood or Bone Marrow: 2 mL collected in a Purple Top- EDTA Tube (0.5 mL minimum)
Cause for Rejection:
Quantity Not Sufficient Specimen Not Received Specimen Mislabeled Specimen Not Labeled Broken/Spilled in Transport Hemolyzed Specimen Clotted Unacceptable Type or Source Submitted Wrong Container Improperly Preserved/Processed Sample Stored at Incorrect Temperature Sample Exceeds Holding Time
Post-Transplant Engraftment (Chimerism), DNA Assay
Test ID/Workstation :
LAB4801
Specimen Type:
Blood Bone Marrow
Collection Volume:
Blood or Bone Marrow: 2 mL collected in a Purple Top- EDTA Tube (0.5 mL minimum)
Cause for Rejection:
Quantity Not Sufficient Specimen Not Received Specimen Mislabeled Specimen Not Labeled Broken/Spilled in Transport Hemolyzed Specimen Clotted Unacceptable Type or Source Submitted Wrong Container Improperly Preserved/Processed Sample Stored at Incorrect Temperature Sample Exceeds Holding Time