Transplant Monitor

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. Transplant Monitor
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Test ID/Workstation :

CD3PR SUMMA

Specimen Type:

Blood

Tube Type:

Purple top (EDTA): Whole Blood

Collection Volume:

5.0 mL

Cause for Rejection:

Clotted or refrigerated

Storage:

Ambient

Availability:

Sent to reference lab

Methodology:

Flow Cytometry

Special Instructions:

Do not refrigerate specimen.

Lab/Phone:

330-543-8418

TAT:

72 hours

Additional Info:

Reference range is available on patient report

CPT Code:

88180

Panel Includes:

CD2, CD3 and CD25

Synonyms:

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Transplant Monitor

Infectious Disease Laboratories : Immunology

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