Vitamin D 1,25 Dihydroxy

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 D 1,25 Dihydroxy
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

VD125 MAYO

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube or Gold top SST (serum separator)

Collection Volume:

4.0 mL (minimum 2.0 mL)

Cause for Rejection:

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

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

Lab/Phone:

330-543-8418

TAT:

2-4 days

Additional Info:

Reference Range:

Males:

< 16 years: 24-86 pg/mL

> or = 16 years: 18-64 pg/mL

Females:

<16 years: 24-86 pg/mL

> or = 16 years: 18-78 pg/mL

CPT Code:

82652

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Vitamin D 1,25 Dihydroxy

Centralized Core Laboratory : Chemistry

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