TSH

Centralized Core Laboratory : Special 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. TSH
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Test ID/Workstation :

TSH SCRED

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

1.0 mL (minimum 0.7 mL)

Cause for Rejection:

Hemolysis

Storage:

Frozen

Availability:

Mon-Fri (0800-1600)

Methodology:

Chemiluminescent Assay

Special Instructions:

Do not use serum separator tube. Specimen must be in lab by 1300 for same day results. Specimen from a newborn should be drawn 2-3 days after birth.

Lab/Phone:

330-543-8484

TAT:

1 hour

Additional Info:

Reference range: 0.35-5.50 ulU/mL

CPT Code:

84443

Synonyms:

Thyroid Stim Hormone; Thryotropin (Stim) Hormone

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TSH

Centralized Core Laboratory : Special Chemistry

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