Somatostatin

Centralized Core Laboratory - Mayo Clinic Laboratories : Send Out

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. Somatostatin
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

SOMAT

Test Workstation :

MAYO

Specimen Type:

Blood

Tube Type:

Call lab- Mayo Misc. Tube- GI Preservative

Collection Volume:

10.0 mL (minimum 3.0 mL)

Cause for Rejection:

Mild Hemolysis, Mild Lipemia

Storage:

Critical Frozen

Availability:

Sent to reference lab

Methodology:

Direct Radioimmunoassay (RIA)

Special Instructions:

Collect 10.0 mL of blood in special tube containing G.I Preservative (Mayo Supply number T125). Specimen should be separated and 3.0 mL plasma frozen as soon as possible. 1. Patient should be fasting 1012 hours prior to collection. 2. Patient should not be on any antacid medication or medications that affect insulin secretion or intestinal motility, if possible, for at least 48 hours prior to collection. For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly).

Lab/Phone:

330-543-8418

TAT:

7-11 days

Additional Info:

Reference range available on report

CPT Code:

84307

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Somatostatin

Centralized Core Laboratory - Mayo Clinic Laboratories : Send Out

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