Smooth Muscle Ab Screen (reflex titer if Positive)
Centralized Core Laboratory - Mayo Clinic Laboratories :
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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. Smooth Muscle Ab Screen (reflex titer if Positive)
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SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
SMOAS
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Serum Separator tube (SST-no anticoagulant)-preferred,
or Red top (no anticoagulant) tube
Collection Volume:
2.0 mL (minimum 1.0 mL )
Cause for Rejection:
Gross hemolysis, gross lipemia
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Indirect Immunofluorescence (IFA)
Special Instructions:
If smooth muscle antibody screen (SMA) is equivocal or positive then the SMA titer will be performed at an additional charge.
Lab/Phone:
330-543-8418
TAT:
2-4 days
Additional Info:
Reference range: Negative
CPT Code:
86015; 86015 (if appropriate)
Smooth Muscle Ab Screen (reflex titer if Positive)
Test ID/Workstation :
SMOAS
Specimen Type:
Blood
Tube Type:
Serum Separator tube (SST-no anticoagulant)-preferred,
or Red top (no anticoagulant) tube
Collection Volume:
2.0 mL (minimum 1.0 mL )
Cause for Rejection:
Gross hemolysis, gross lipemia
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Indirect Immunofluorescence (IFA)
Special Instructions:
If smooth muscle antibody screen (SMA) is equivocal or positive then the SMA titer will be performed at an additional charge.
Lab/Phone:
330-543-8418
TAT:
2-4 days
Additional Info:
Reference range: Negative
CPT Code:
86015; 86015 (if appropriate)
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