Testosterone, Free
| 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. Testosterone, Free | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
TESFR
Specimen Type:
Blood
Tube Type:
Serum Red Top Tube (serum gel/SST are NOT acceptable)
Collection Volume:
1 mL
Minimum Volume:
0.6 mL
Cause for Rejection:
Serum separator tube or serum gel.
Storage:
Refrigerated
Methodology:
Quantitative LC-MSMS/Immunoassay/Calculation
Lab/Phone:
330-543-0223
TAT:
3-7 days
Additional Info:
Free testosterone is calculated based on results from total testosterone (run by LC-MSMS) and sex-hormone binding globulin (run by immunoassay). Reference range available on patient report.
CPT Code:
84402, 88403
Panel Includes:
Total and Free Testosterone and Sex-hormone Binding Globulin (SHBG)
