Raji Cell Assay

- : Immunology

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. Raji Cell Assay
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

RAJI

Test Workstation :

CLEVE

Specimen Type:

Blood

Tube Type:

Gold top SST (serum separator tube, no anticoagulant)

Collection Volume:

2.5 mL (minimum 1.5 mL)

Cause for Rejection:

Non frozen samples or samples exposed to repeated freeze/thaw cycles

Storage:

Frozen

Availability:

Sent to reference lab

Methodology:

Flow Cytometry (FC)

Special Instructions:

Allow complete clotting of red blood cells up to 1 hour, then separate serum from cells within 30 minutes and freeze immediately.

Lab/Phone:

330-543-8418

TAT:

3-11 days

Additional Info:

Reference range available on Patient report

CPT Code:

86332

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Raji Cell Assay

- : Immunology

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