Stickler Syndrome Type III

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. Stickler Syndrome Type III
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

STL3 CTGT

Specimen Type:

Whole Blood

Tube Type:

Purple top (EDTA) tube

Collection Volume:

5.0 mL( minimum 4.0 mL)

Storage:

Ambient

Availability:

Sent to Reference Laboratory

Methodology:

DNA Sequencing

Special Instructions:

Requires Informed Consent for Genetic Testing

Lab/Phone:

330-543-8418

TAT:

3-4 weeks

Additional Info:

Whole blood should be refrigerated until shipped. All samples can be shipped ambient temperature vian an overnight courier.

CPT Code:

81479

While we are ranked among the best children's hospitals in the country, it's our compassionate approach to treatment that makes us truly exceptional. Through a combination of revolutionary treatments and extraordinary patient experiences, our care does more than heal. It brings the entire family together for emotional support and understanding across multiple locations to reach you in the community where you live. Learn more...