TSH
| 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: |
| Hospital: |
Test ID :
TSH
Test Workstation :
E8011
Specimen Type:
Blood
Tube Type:
Green top (lithium heparin) tube
Collection Volume:
1.5 mL
Minimum Volume:
500 uL
Preferred Volume:
1.5 mL
Storage:
Shipping- Send Refrigerated; Storage- Room Temp: 8 days; Refrigerated: 14 days; Frozen: 24 months
Availability:
24 hours/day, 7 days/week
Methodology:
Roche-ECLIA sandwich principle
Lab/Phone:
330-543-8418
TAT:
4 hours
Additional Info:
Reference range is age dependent, available on patient report
CPT Code:
84443
Synonyms:
Thyroid Stim Hormone; Thryotropin (Stim) Hormone
