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Toxoplasma Pregnancy Panel with Avidity

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

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

TXAVI TSL

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

3.0 mL (minimum 1.0 mL)

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:

Toxoplasma IgG: < 1:16

Toxoplasma IgM (ELISA):

0.0-1.6 = Negative

1.7 - 1.9 = Equivocal

> or = 2.0 = Positive

CPT Code:

8677786778

Panel Includes:

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

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