Troponin T

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. Troponin T
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

TROPT SELIZ

Specimen Type:

Blood

Tube Type:

Green top (lithium heparin) tube

Collection Volume:

2.5mL (minimum 1.5mL)

Cause for Rejection:

Hemolysis

Storage:

Refrigerated

Availability:

Sent to reference lab

Lab/Phone:

330-746-9623

TAT:

2 hours

Additional Info:

Reference value: Female: 0-9 ng/L Male: 0-11 ng/L

CPT Code:

84484

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