Toxoplasma Pregnancy Panel with Avidity

Centralized Core Laboratory - Toxoplasma Serology Lab : Send Out

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. Toxoplasma Pregnancy Panel with Avidity
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

TXAVI

Test Workstation :

TSL

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

4.5 mL

Minimum Volume:

2.0 mL

Cause for Rejection:

Specimen frozen or not refrigerated within 1 hour of the draw and kept refrigerated

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Dyes, Enzyme-Linked Immunosorbent Assay

Lab/Phone:

330-543-8418

TAT:

5-7 days

Additional Info:

Reference range is available on patient report

CPT Code:

86777, 86778. 86777-59

Panel Includes:

Toxoplasma IgG (Dye test), Toxoplasma IgM (ELISA), Toxoplasma Avidity

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Toxoplasma Pregnancy Panel with Avidity

Centralized Core Laboratory - Toxoplasma Serology Lab : Send Out

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