Vitamin A

Centralized Core 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. Vitamin A
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Test ID/Workstation :

VITA MAYO

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

1.5 mL (minimum 1.0 mL)

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

Special Instructions:

Patient preparation: 12- 14 hour fast prior to collection. Separate serum from cells immediately. Protect specimen from light. (Infants-draw prior to next feeding). For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly).

Lab/Phone:

330-543-8418

TAT:

2-5 days

Additional Info:

Reference range: 0-6 years: 11.3-64.7 mcg/dL 7-12 years: 12.8-81.2 mcg/dL 13-17 years: 14.4-97.7 mcg/dL >or= 18 years: 32.5-78.0 mcg/dL

CPT Code:

84590

Synonyms:

Retinol

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Vitamin A

Centralized Core Laboratory : Chemistry

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