Thrombin Time
| 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. | |
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| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
TT2
Test Workstation :
MAYO
Specimen Type:
Blood - Plasma
Tube Type:
Blue top (sodium citrate) tube
Collection Volume:
Minimum 2.7 mL in 2.7 mL Blue top (Sodium citrate) tube.
Minimum Volume:
Minimum 1.8 mL in 1.8 mL Blue top (Sodium citrate) tube.
Storage:
Frozen
Availability:
Sent to reference lab
Methodology:
Optical Clot-Based
Special Instructions:
- Days Performed: MonFri
- Centrifuge, remove plasma, centrifuge again.
Please send 1 mL frozen citrated plasma.
- Fasting specimen preferred.
Lab/Phone:
330-543-8416
TAT:
2-4 days
Additional Info:
Reference range: 15.8-24.9 seconds
CPT Code:
85670
