Seafood Allergen Profile

Centralized Core Laboratory : 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. Seafood Allergen Profile
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Test ID/Workstation :

SEAFP MAYO

Specimen Type:

Blood

Tube Type:

Red top ( no anticoagulant) tube

Collection Volume:

2.0 mL (minimum 1.5 mL)

Storage:

Refrigerated

Availability:

Sent to Mayo Medical Laboratory

Methodology:

Fluorescence Enzyme Immunoassay (FEIA)

Lab/Phone:

330-543-8418

TAT:

1-3 days

Additional Info:

Reference range is available on patient report

CPT Code:

86003

Panel Includes:

Codfish IgE, Shrimp IgE, Crab IgE, Tuna IgE, Lobster IgE

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Seafood Allergen Profile

Centralized Core Laboratory : Immunology

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