T3(Triiodothyronin), Reverse, Serum

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(Triiodothyronin), Reverse, Serum
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

RT3

Test Workstation :

MAYO

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

2.0mL(minimum 1.0mL)

Cause for Rejection:

Grossly hemolyzed

Storage:

Refrigerated

Availability:

Sent to Reference Laboratory

Methodology:

Liquid Chromatography-Tandem Mass Spectrometry

Lab/Phone:

330-543-8418

TAT:

2-6 days

Additional Info:

Reference range available on patient report

CPT Code:

84482