Thrombin Time

Centralized Core Laboratory : Hematology

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. Thrombin Time
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Test ID/Workstation :

TT2 ENDO

Specimen Type:

Blood

Tube Type:

Blue top (sodium citrate) tube

Collection Volume:

2.7 mL

Cause for Rejection:

Storage:

Frozen

Availability:

Sent to reference lab

Methodology:

Clotting Assay

Special Instructions:

Days Performed: Mon-Fri Please send 1 mL frozen citrated plasma. If collected at an offsite location, send by a STAT Courier to Hospital lab.

Lab/Phone:

330-543-8416

TAT:

1-3 days

Additional Info:

Reference range: 0.0-23.0 seconds

CPT Code:

85670

Synonyms:

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Thrombin Time

Centralized Core Laboratory : Hematology

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