Topiramate

Centralized Core Laboratory : Chemistry

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. Topiramate
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Test ID/Workstation :

TOPIR MAYO

Specimen Type:

Blood

Tube Type:

Red top

Collection Volume:

2.5 mL (minimum 1.5 mL)

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Enzyme-Multiplied Immunoassay Technique (EMIT)

Lab/Phone:

330-543-8418

TAT:

1-2 days

Additional Info:

Reference range Depends on Clinical use: Anticonvulsant: 5.0-20.0 mcg/mL Psychiatric: 2.0-8.0 mcg/mL

CPT Code:

80201

Synonyms:

Topamax

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Topiramate

Centralized Core Laboratory : Chemistry

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