Sequential Screen, Second Trimester

Centralized Core Laboratory : Special 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. Sequential Screen, Second Trimester
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

SEQ2 GENZY

Specimen Type:

Blood

Tube Type:

Gold top SST (Serum Separator tube, no anticoagulant)

Collection Volume:

2.0 mL (minimum 1.0 mL)

Storage:

Refrigerated

Availability:

Sent to Reference lab

Methodology:

Enzyme Linked Immunoassay (ELISA)

Lab/Phone:

330-543-8418

TAT:

2-3 days after specimen received in reference lab

Additional Info:

Reference range is available on patient report

CPT Code:

8.21058470282677e+19

Panel Includes:

AFP HCG, Qnt Estriol Inhibin A

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