Rheumatoid Factor IgM
| 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. Rheumatoid Factor IgM | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
RFIGM
Test Workstation :
QUEST
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
3.0 mL
Minimum Volume:
0.8 mL
Cause for Rejection:
SST Tube
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Immunoturbidimetric
Lab/Phone:
330-543-8418
TAT:
1-7 days
Additional Info:
Reference range is available on patient report
< or = 6 Negative
>6 Positive
CPT Code:
83520
