Proinsulin
| 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. Proinsulin | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
PROIN
Test Workstation :
MAYO
Specimen Type:
Plasma
Tube Type:
EDTA top (lavender) tube - tube must be prechilled
Collection Volume:
1.5 mL
Minimum Volume:
0.75 mL
Cause for Rejection:
Specimen not drawn in a prechilled EDTA tube.
Patient not fasting 8 hours prior to collection.
Storage:
Frozen
Availability:
Sent to reference lab
Methodology:
Electrochemiluminescent Assay
Special Instructions:
After draw, chill the whole blood on ice for at least 10 minutes, then spin down in a refrigerated centrifuge.
Lab/Phone:
330-543-8418
TAT:
2-5 days
Additional Info:
Reference range: 3.6-22 pmol/L
CPT Code:
84206
