Somatostatin

Centralized Core Laboratory : 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. Somatostatin
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

SOMAT MAYO

Specimen Type:

Blood

Tube Type:

Mayo Misc. Tube

Collection Volume:

10.0 mL (minimum 3.0 mL)

Storage:

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 10-12 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:

5-7 days

Additional Info:

Reference range available on report

CPT Code:

84307