T3 Total
| 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. T3 Total | |
| 2. | |
| 3. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
T3TOT
Test Workstation :
e8011
Specimen Type:
Blood
Tube Type:
Green top (lithium heparin)
Alternate Tube Type:
Red top (serum), Purple top (EDTA)
Minimum Volume:
0.5 mL
Preferred Volume:
1.5 mL
Storage:
Refrigerated
Availability:
24 hours a day, 7 days a week
Methodology:
Electrochemiluminescence Immunassay
Lab/Phone:
330-543-8418
TAT:
Routine 4 hours and Stat 1 hour
Additional Info:
Reference range available on patient report
CPT Code:
84480
Synonyms:
T3 Suppression,T3 Total, Serum,Total T3, Serum, Triiodothyronine (T3),Triiodothyronine, Total T3,T3 (Triiodothyronine), Total Only, Serum,Thyroid Function Cascade, Triiodothyronine
