We are experiencing exceptionally high volumes in our emergency rooms.
Every patient is important to us, and we are doing all we can to provide care quickly and efficiently.

Rapamune

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. Rapamune
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

RAPAM MAYO

Specimen Type:

Blood

Tube Type:

Purple top (EDTA) tube: Whole Blood

Collection Volume:

7.5 mL (minimum 2.5 mL)

Cause for Rejection:

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

High Performance Liquid Chromatography/Tandem Mass Spectrometry

Special Instructions:

Collect immediately prior to next dose. Indicate date, time and dosage of last dose. Do not centrifuge. Send specimen in original tube.

Lab/Phone:

330-543-8418

TAT:

2-4 days

Additional Info:

Reference range: 4-20 ng/mL

CPT Code:

80195

Synonyms:

Sirolimus

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