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Tetanus Toxoid IgG Abs

Infectious Disease Laboratories : Immunology

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. Tetanus Toxoid IgG Abs
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

TETTX MAYO

Specimen Type:

Blood

Tube Type:

Red top(no anticoagulant)tube

Collection Volume:

1.5 mL(1.0 mL minimum)

Cause for Rejection:

Gross hemolysis, Gross lipemia

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Enzyme Immunoassay

Lab/Phone:

330-543-8418

TAT:

1-4 days

Additional Info:

Reference range: > or = 0.16 IU/mL suggests a vaccine response

CPT Code:

86317

Synonyms:

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