VWF GP1bM Activity
| 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. VWF GP1bM Activity | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
GP1BM
Test Workstation :
ACOAG
Specimen Type:
Blood
Tube Type:
Blue top ( sodium citrate)tube
Collection Volume:
2.7 mL (minimum 1.8 mL) Must use appropriate sodium citrate tube based on volume of blood drawn (1.8 mL or 2.7 mL tube)
Cause for Rejection:
Samples hemolyzed, clotted, diluted with IV fluid; contaminated with heparin; improperly filled; received >4 hours after drawn.
Storage:
Ambient-Whole Blood
Availability:
Daily (0700-1500)
Methodology:
Photometric/Turbidometric
Special Instructions:
If collected at an offsite location, send whole blood by STAT courier to Akron Children's Laboratory. Must be received with 4 hours.
Lab/Phone:
330-543-8416
TAT:
7 days
CPT Code:
85397
