T Cell Subset

Centralized Core Laboratory - Summa Akron City Hospital : 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. T Cell Subset
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

TCELL

Test Workstation :

SUMMA

Specimen Type:

Whole Blood

Tube Type:

Purple top (EDTA) tube: Whole Blood

Collection Volume:

5.0 mL

Minimum Volume:

1.0 mL

Cause for Rejection:

Clotted or refrigerated specimen

Storage:

Ambient

Availability:

Sent to reference lab

Methodology:

Flow Cytometry

Special Instructions:

Do not refrigerate specimen.

Lab/Phone:

330-543-8418

TAT:

1-3 days

Additional Info:

Reference range is available on patient report

CPT Code:

86359, 86360

Panel Includes:

Absolute count and percentage of total: CD3, CD4, CD8, and CD4/CD8 Ratio

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T Cell Subset

Centralized Core Laboratory - Summa Akron City Hospital : Send Out

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