Prealbumin

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. Prealbumin
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

PALB ACHM5

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube; Do NOT use Serum Separator Tube

Collection Volume:

1.5 mL

Storage:

Shipping- Send Refrigerated; Storage- Room Temp: 3 days; Refrigerated: 6 months; Frozen: 1 year

Availability:

24 hours/day, 7 days/week

Methodology:

Roche-Turbidimetric

Lab/Phone:

330-543-8417

TAT:

4 hours

CPT Code:

84134

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