Centralized Core Laboratory - Mayo Clinic Laboratories :
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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. T4 Thyroxine Total Only, Serum
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SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
T4TOT
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Gold Top SST (Serum Separator Tube)
Collection Volume:
2.5 mL
Minimum Volume:
1.9 mL
Cause for Rejection:
Grossly hemolyzed
Storage:
Refrigerated
Availability:
Sent to Reference Lab performed Monday through Friday
Methodology:
Electrochemiluminescence Immunoassay
Special Instructions:
This test cannot be used in patients receiving treatment with lipidlowering agents containing dextrothyroxine unless therapy is discontinued for 4 to 6 weeks to allow the physiological state to become reestablished prior to testing.
Lab/Phone:
330-543-8418
TAT:
1-3 days
Additional Info:
Reference Range: See reference lab ranges on report
CPT Code:
84436
Synonyms:
SynThyroid
T4, Serum
Tetraiodothyronine
Thyroid Hormone
Thyroxine, Total
T4 Total Only, S
Thyroxine
Thyroxine
T4 Thyroxine Total Only, Serum
Test ID/Workstation :
T4TOT
Specimen Type:
Blood
Tube Type:
Gold Top SST (Serum Separator Tube)
Collection Volume:
2.5 mL
Cause for Rejection:
Grossly hemolyzed
Storage:
Refrigerated
Availability:
Sent to Reference Lab performed Monday through Friday
Methodology:
Electrochemiluminescence Immunoassay
Special Instructions:
This test cannot be used in patients receiving treatment with lipidlowering agents containing dextrothyroxine unless therapy is discontinued for 4 to 6 weeks to allow the physiological state to become reestablished prior to testing.
Lab/Phone:
330-543-8418
TAT:
1-3 days
Additional Info:
Reference Range: See reference lab ranges on report
CPT Code:
84436
Synonyms:
SynThyroid
T4, Serum
Tetraiodothyronine
Thyroid Hormone
Thyroxine, Total
T4 Total Only, S
Thyroxine
Thyroxine
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