TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC TEST SPECIFICATION GUIDE The Test Specification Guide will be available to CML HealthCare SCC’s / POCC’s, and to all CML clients upon request (electronically and/or hard copy). This guide outlines the information needed to access the services provided by CML Healthcare for the procurement of laboratory specimens. Each individual test listing is arranged in a consistent format, providing specific information. This guide provides the following information:  Test name, synonyms or other common names for the test and the computer testing code.  Patient preparation, including patient care instruction prior to, or during specimen collection, or performance of the test.  Patient clinical information that is required because of its relevance to the determination of the diagnosis, and to the testing protocol. The clinical information includes, but is not limited to, patient history, date of birth, sex, ethnic background, height and weight.  Specimen collection instructions, including specimen type, container or vacutainer tube, specific days and times for sample procurement.  Post specimen collection instructions including storage and transportation instructions, testing facility, estimated time for test results availability, and billing information.  Unless specified otherwise, specimen storage and transport is at room temperature. TSG GENERAL INFORMATION Page 1 of 6 CML HealthCare Inc Test Specification Guide 16954 Version: 6.0 5-Mar-2014 DOI: Sept/2005 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC SPECIMEN PROCESSING INFORMATION Tests are listed in the manual under the following headings: TEST: The test is listed first by its most common standard nomenclature and underneath any alternate names. Each test request is specifically cross-referenced. CODE: The test code(s) must always be “Data Entered” unless otherwise specified. SPECIMEN REQUIREMENT: Blood test requests are indicated as Serum, Plasma, or Blood. Instructions will specify either minimum volume required or centrifuge only. When a minimum volume amount is indicated, the vacutainer tube must be centrifuged, and an aliquot separated into a plastic transport tube. BILLING: All tests are considered OHIP or non-OHIP payable. Tests indicated with “OHIP” are covered by OHIP and are patient payment exempt upon presentation of a valid Ontario Health Card. Tests indicated with a dollar amount after the test, require patient payment before specimen collection. TSG GENERAL INFORMATION Page 2 of 6 CML HealthCare Inc Test Specification Guide 16954 Version: 6.0 5-Mar-2014 DOI: Sept/2005 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC: The laboratory, which performs the test, is designated by a unique abbreviation. Abbreviation Testing Facility Testing Facility Phone # BAGL Bay Area Genetic Laboratory 905-385-1045 CML CML HealthCare 905-565-0043 CVH Credit Valley Hospital DYN Dynacare HLRC Hamilton Lab Reference Center HOSP Designated Hospital HRL Hemostasis Reference Laboratory KGH Kingston General Hospital LHSC London Health Services Center LL MSH Life Labs Mount Sinai Hospital MUMC McMaster University Medical Centre NYGH North York General Hospital 905-813-4335/4214 1-800-265-5946 905-577-1477 905-521-2100 x 42667 519-685-8500 ext.77736 1-877-404-0637 416-586-4800 905-521-2100 x 75022 416-756-6055 OGH Oshawa General Hospital 1-877-677-5463 PHL Public Health Labs 416-235-5952 PLSI Phenomenome LabService Inc 306-244-8233 SBH Sunnybrook Health Science Centre 416-480-4652 SKH Hospital for Sick Kids 416-813-1500 SMH St. Michael’s Hospital 416-360-4000 SJH St. Joseph’s Hospital 905-521-6036 TGH Toronto General Hospital 416-586-8510 VTF Various Testing Facilities TSG GENERAL INFORMATION Page 3 of 6 CML HealthCare Inc Test Specification Guide 16954 Version: 6.0 5-Mar-2014 DOI: Sept/2005 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. LOC TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC LOCATION INDEX ON REPORTS LOCATION NAME FACILITY CODE ADDRESS CML HEALTHCARE – MAIN LABORATORY 6560 KENNEDY ROAD, MISSISSAUGA L5T 2X4 70 MOUNT SINAI HOSPITAL 600 UNIVERSITY AVENUE, TORONTO M5G 1X5 82 UNIVERSITY HEALTH NETWORK (TORONTO GENERAL SITE) 190 ELIZABETH AVENUE, TORONTO M5G 2C4 83 NORTH YORK GENERAL HOSPITAL 4001 LESLIE STREET, TORONTO M2K 1E1 84 LAKERIDGE HEALTH CORPORATION 1 HOSPITAL COURT, OSHAWA L1G 2B9 85 CREDIT VALLEY HOSPITAL 2200 EGLINTON AVE. W., MISSISSAUGA L5M 2N1 86 SUNNYBROOK HEALTH SCIENCE CENTRE 2075 BAYVIEW AVENUE, TORONTO M4N 3M5 87 PUBLIC HEALTH LAB – TORONTO BRANCH 81 RESOURCE ROAD, TORONTO M9P 3T1 90 GAMMA DYNACARE 245 PALL MALL STREET, LONDON N6A 1P4 92 LIFE LABS 100 INTERNATIONAL BLVD, TORONTO M9W 6J6 94 HAMILTON LAB REFERENCE CENTRE 50 CHARLTON AVE. E., HAMILTON L8N 4A6 95 HEMOSTASIS REFERENCE LABORATORY 711 CONCESSION ST, 15(H) WING, 2ND FL L8V 1C3 70 PHENOMENOME LABORATORY SERVICE INC. 103-407 DOWNEY ROAD, SASKATOON, SASKATCHEWAN S7N 4L8 BAY AREA GENETIC LABORATORY 205B-565 SANATORIUM ROAD, SIR WILLIAM OSLER BLDG, HAMILTON L9C 7N4 TSG GENERAL INFORMATION Page 4 of 6 CML HealthCare Inc Test Specification Guide 16954 Version: 6.0 5-Mar-2014 DOI: Sept/2005 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. 96 TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LIST OF TESTS MIDWIVES ARE PERMITTED TO ORDER (TESTS FOR MOTHERS):  HEMATOLOGY CHEMISTRY/RIA ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ Glucose Glucose Challenge, Gestational Screen Urinalysis – Routine Chemical Urinalysis – Microscopic examination Estriol HCG Hepatitis associated antigen or antibody immunoassay Alphafetoprotein Screen Albumin Quantitative Serum Ferritin Serum Folate ‐ ‐ W.B.C differential count (includes R.B.C Morphology and platelet estimate) W.B.C (lkc count, excluding whole blood manual method) Hematocrit Hemoglobin Sickle cell solubility test (screen) Kleihauer ‐ Blood Group per antigen ‐ ‐ ‐ ‐ Cervicovaginal specimens ‐ ‐ ‐ ‐ CYTOLOGY ‐ BACTERIOLOGY Antibiotic Sensitivity ‐ Chlamydia ‐ Culture – Cervical, Vaginal (includes G.C) ‐ Culture – Other swabs or pus IMMUNOLOGY ‐ ‐ ‐ ‐ Pregnancy test Virus antibodies – hemagglutination inhibition or ELISA technique Non-cultural, indirect antibody or antigen assays by fluorescence, agglutination or ELISA technique (toxoplasmosis) HTLVIII/LAV antibody screen by ELISA technique (HIV Antibody) Culture – Urine Virus Isolation Wet preparation (for fungus, tricomonas, parasites) Strep B rapid screen IMMUNOHEMATOLOGY ‐ ‐ ‐ ‐ ‐ Antibody Identification – Incomplete antibody Antibody screen Blood group – ABO and Rho (D) Direct Anti-human globulin test Direct Anti-human globulin test          TSG GENERAL INFORMATION Page 5 of 6 CML HealthCare Inc Test Specification Guide 16954 Version: 6.0 5-Mar-2014 DOI: Sept/2005 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. LOC TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC  LIST OF TESTS MIDWIVES ARE PERMITTED TO ORDER (TESTS FOR NEWBORNS): CHEMISTRY/RIA ‐ ‐ ‐ ‐ Bilirubin – Total Bilirubin – Conjugated Glucose TSH/PKU Newborn screening HEMATOLOGY ‐ ‐ ‐ ‐ ‐ W.B.C differential count (includes R.B.C Morphology and platelet estimate) Platelet count W.B.C (lkc count, excluding whole blood manual method) Hematocrit Hemoglobin IMMUNOHEMATOLOGY ‐ Blood group – ABO and Rho (D) LIST OF TESTS MIDWIVES ARE PERMITTED TO ORDER (TESTS FOR FATHERS/DONORS): CHEMISTRY/RIA ‐ ‐ Urinalysis – microscopic examination Hepatitis associated antigen or antibody immunoassay HEMATOLOGY ‐ ‐ BACTERIOLOGY ‐ ‐ ‐ ‐ ‐ Antibiotic Sensitivity Chlamydia Culture – other swabs or pus Virus isolation Wet preparation (for fungus, trichomonas, parasites) Sickle cell solubility test (screen) Blood group per antigen IMMUNOHEMATOLOGY ‐ Blood group – ABO and Rho (D) IMMUNOLOGY ‐ HTLVIII/LAV antibody screen by ELISA technique (HIV Antibody) TSG GENERAL INFORMATION Page 6 of 6 CML HealthCare Inc Test Specification Guide 16954 Version: 6.0 5-Mar-2014 DOI: Sept/2005 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC Refer to ALBUMIN/GLOBULIN RATIO A/G RATIO (ALBUMIN/ GLOBULIN RATIO) Refer to HEMOGLOBIN A1C A1C (GLYCOSYLATED HEMOGLOBIN) (HbA1C) (HEMOGLOBIN A1C) Refer to BLOOD GROUP ABO, RhD (ABO & TYPE) (BLOOD GROUP & RhD) (BLOOD GROUP) (Rh TYPING) Refer to BLOOD GROUP PHENOTYPE ABO, Rh(D), GENOTYPE (BLOOD GROUP, Rh(D) & GENOTYPE) (GENOTYPE) E.G. ANTIGENS C, E, c, e ABO & ANTIBODY SCREEN (ABO & SCREEN) (PRENATAL SCREEN) (TYPE & SCREEN) (BLOOD GROUP PRENATAL ANTIBODY) Refer to BLOOD GROUP and Refer to ANTIBODY SCREEN Refer to ANGIOTENSIN CONVERTING ENZYME ACE (ANGIOTENSIN CONVERTING ENZYME) ACETAMINOPHEN 079A (TYLENOL) Serum PLAIN RED Minimum Volume required: 2 mL Record time in hours that have elapsed between last dose and specimen collection. OHIP HLRC OHIP DYN OHIP CML TAT – 5 days ACETONE 002 (KETONES) Serum Centrifuge only. Do not open tube Refrigerate during storage and transport. GOLD SST TAT – 14 days ACETONE, QUALITATIVE (KETONES QUALITATIVE) 254–5 Urine 10 mL random urine Submit in a YELLOW cap conical tube. TAT – 1 day TEST SPECIFICATION GUIDE - SECTION A Page 1 of 19 CML HealthCare Inc Test Specification Guide 18356 Version: 15.0 21-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE ACETYLCHOLINE RECEPTOR ANTIBODY 9144 SPECIMEN REQUIREMENT Serum Centrifuge only VACUTAINER BILL GOLD SST LOC $130.00 HLRC OHIP DYN OHIP DYN TAT – 30 days ACETYL CHOLINESTERASE 057R (RBC CHOLINESTERASE) Red cells 2 LAVENDER Centrifuge tubes within 1-hour of collection Aliquot and discard plasma from lavender tubes Send red cells only Keep tubes together with an elastic Store and transport refrigerated TAT – 15 days Refer to SALICYLATE ACETYLSALICYLIC ACID (ASA) (ASPIRIN) (SALICYLATE) ACETYL CHOLINESTERASE 057R (RBC CHOLINESTERASE) Red cells 2 LAVENDER Centrifuge tubes within 1-hour of collection Aliquot and discard plasma from lavender tubes Send red cells only Keep tubes together with an elastic Store and transport refrigerated TAT – 15 days ACYLCARNITINE (FRACTIONATION) 9341 Centrifuge, separate into transfer tube GREEN and freeze immediately. Store and send frozen $70.00 TAT – 15 days ACID FAST BACILLUS Refer to MYCOBACTERIA TUBERCULOSIS DETECTION (AFB) (MYCOBACTERIA TUBERCULOSIS DETECTION) (T.B. CULTURE) (TUBERCULOSIS CULTURE) ACID PHOSPHATASE, PROSTATIC TEST NO LONGER AVAILABLE ACID PHOSPHATASE TOTAL TEST NO LONGER AVAILABLE ACTH Refer to CORTICOTROPIN (ADRENOCORTICOTROPIC HORMONE) (CORTICOTROPIN) TEST SPECIFICATION GUIDE - SECTION A Page 2 of 19 CML HealthCare Inc Test Specification Guide 18356 Version: 15.0 21-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. HLRC TEST NAME ACTIVATED PROTEIN C RESISTANCE CODE 9901 (APCR) SPECIMEN REQUIREMENT Plasma Minimum Volume required: 2 mL Patient should not be on anticoagulant therapy VACUTAINER LIGHT BLUE BILL $60.00 LOC HLRC FREEZE PLASMA AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines TAT – 25 days ACUTE LEUKEMIA PHENOTYPING Refer to LYMPHOCYTE MARKERS, T & B CELLS (LYMPHOCYTE MARKERS, T & B CELLS) (LYMPHOPROLIFERATIVE DISEASE PHENOTYPING) Refer to RUBELLA VIRUS ANTIBODY, IgM ACUTE RUBELLA (RUBELLA VIRUS ANTIBODY, IGM) ADAMTS - 13 9535 (THROMBOTIC THROMBOCYTOPENIC PURPURA) Both Red and Blue vacutainers are required. PLAIN RED Centrifuge, separate serum and plasma AND LIGHT BLUE into separate transfer tubes and freeze both ASAP. Store and send frozen. N/C MUMC FORM AVAILABLE ON CML WEBSITE SEROLOGY NO LONGER AVAILABLE ADENOVIRUS ANTIBODY ADENOVIRUS PCR 9068 Specimen must be sent on dry ice. LAVENDER A completed molecular microbiology requisition must be sent with specimen. (See also Ministry of Health guidelines) $50.00 SKH FORM AVAILABLE ON CML WEBSITE Refer to VASOPRESSIN ADH (ANTI–DIURETIC HORMONE) (ADH VASOPRESSIN) (VASOPRESSIN) ADRENAL ANTIBODIES 9904 Serum Centrifuge only GOLD SST TAT – 15 days ADRENOCORTICOTROPIC HORMONE Refer to CORTICOTROPIN (ACTH) (CORTICOTROPIN) TEST SPECIFICATION GUIDE - SECTION A Page 3 of 19 CML HealthCare Inc Test Specification Guide 18356 Version: 15.0 21-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. OHIP HLRC TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC GOLD SST OHIP CML GOLD SST OHIP CML OHIP CML Refer to MYCOBACTERIA TUBERCULOSIS DETECTION AFB (ACID FAST BACILLUS) (MYCOBACTERIA TUBERCULOSIS DETECTION) (T.B. CULTURE) (TUBERCULOSIS CULTURE) Refer to COLD AGGLUTININS SCREEN AGGLUTINATION REACTION SCREEN (COLD AGGLUTININS SCREEN) Refer to HIV 1 & 2 ANTIBODY SCREEN AIDS (HIV) (HIV 1 & 2 ANTIBODY SCREEN) (HIV SEROLOGY) Refer to GLIADIN ANTIBODIES AGA (ANTI–GLIADIN ANTIBODY) (GLIADIN ANTIBODIES) Refer to DELTA-AMINOLEVULINATE ALA (DELTA–AMINOLEVULINATE) ALANINE AMINO TRANSAMINASE 223 (ALT) (SGPT) ALBUMIN Serum Centrifuge only TAT – 1 day 005 Serum Centrifuge only TAT – 1 day ALBUMIN, QUALITATIVE 254– 3 (PROTEIN, TOTAL QUALITATIVE) Urine 10 mL random urine Submit in a YELLOW cap conical tube. TAT – 2 days Refer to MICROALBUMIN ALBUMIN QUANTITATIVE (MICROALBUMIN) TEST NO LONGER AVAILABLE ALBUMIN/GLOBULIN RATIO (A/G RATIO) ALCOHOLS (GC) 9242 Whole Blood GRAY Includes Methanol, Ethanol, Acetone, Isopropanol Do not open tube. Do not separate. Use iodine swab to cleanse venepuncture site. This test is not available for CCC use. This test is only for use at Kennedy Road for hospital patients TAT – 4 days TEST SPECIFICATION GUIDE - SECTION A Page 4 of 19 CML HealthCare Inc Test Specification Guide 18356 Version: 15.0 21-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. OHIP HRLC TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC Refer to ETHANOL ALCOHOL- ETHYL (ETHANOL) Refer to ISOPROPANOL ALCOHOL- ISOPROPYL (ISOPROPANOL) Refer to METHANOL ALCOHOL- METHYL (METHANOL TEST NO LONGER AVAILABLE ALDOLASE ALDOSTERONE 300 Serum Centrifuge only and aliquot to transfer tube. Ship frozen TAT – 24 days GOLD SST OHIP ALDOSTERONE 300U 24-Hour Urine OHIP 50 mL aliquot – submit in a 90 mL white cap container No preservative Patient must be on normal sodium intake and not receiving diuretics for one week before urine sample is collected. HLRC DYN State total 24-hour volume on the OHIP Requisition, on the specimen container and in “Notes & Instructions”. Retain a duplicate 50 mL sample in the freezer until test is reported. FREEZE URINE AND SEND FROZEN Refer to the General Information Pages for Specimen Processing & Transport Guidelines TAT – 20 days ALKALINE PHOSPHATASE 191 (PHOSPHATASE ALKALINE) (ALP) Serum Centrifuge only GOLD SST OHIP CML 2 GOLD SST OHIP CML TAT – 1 day ALKALINE PHOSPHATASE FRACTIONATION 191 192 (ALKALINE PHOSPHATASE ISOENZYME) (PHOSPHATASE ALKALINE ISOENZYMES) ALLERGIC ALVEOLITIS (ALLERGIC LUNG) (FARMERS LUNG) 9036 Serum Label 1 SST autoChem Label 1 SST Alk. Phos. Fract. Centrifuge only  Testing Includes Total Alkaline Phosphase  TAT – 4 days Serum GOLD SST OHIP Centrifuge only  Do not confuse with Avian Precipitins  Includes M. Faeni and T Vulgaris. To order Allergic Lung Serology please order both Farmer’s Lung Precipitins (SFAR) AND Aspergillus Precipitins (SASPP) TAT – 30 days TEST SPECIFICATION GUIDE - SECTION A Page 5 of 19 CML HealthCare Inc Test Specification Guide 18356 Version: 15.0 21-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. HLRC TEST NAME ALLERGY TESTING CODE SPECIMEN REQUIREMENT See chart (ASIA) (SERUM ALLERGEN TEST) (ALLERGEN SPECIFIC IGE ANTIBODY TEST) (RAST) (ALLERGEN SPECIFIC IMMUNOASSAY) VACUTAINER Serum GOLD SST Min Volume Required: 1ml Centrifuge and aliquot. Store and ship refrigerated. Be specific when free texting allergen name. Can enter up to nine allergens on one accession. TAT – 5 days NOTE: TAT for unlisted allergens is 4-6 weeks. Test Name Test Code Allergy Testing-First Allergen 350-1 Allergy Testing-Second Allergen 350-2 Allergy Testing-Third Allergen 350-3 Allergy Testing-Fourth Allergen 350-4 Allergy Testing-Fifth Allergen 350-5 Allergy Testing-Sixth Allergen 350-6 Allergy Testing-Seventh Allergen 350-7 Allergy Testing-Eighth Allergen 350-8 Allergy Testing-Nineth Allergen 350-9     TEST SPECIFICATION GUIDE - SECTION A Page 6 of 19 CML HealthCare Inc Test Specification Guide 18356 Version: 15.0 21-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. BILL $23.00 LOC HRL TEST NAME ALLERGY TESTING MIX CODE See Chart SPECIMEN REQUIREMENT VACUTAINER Serum GOLD SST Centrifuge and aliquot Store and ship refrigerated Can enter up to four allergen mixes on one accession. Eg: Tree mix, Food mix, Grass mix BILL LOC $23.00 HRL GOLD SST OHIP CML GOLD SST $105.00 HLRC TAT – 5 days Test Name ALPHA 1-ANTITRYPSIN Test Code Allergy Testing- Mix 1 353-1 Allergy Testing- Mix 2 353-2 Allergy Testing- Mix 3 353-3 Allergy Testing- Mix 4 353-4 555 Serum Centrifuge only TAT – 2 days ALPHA–1 ANTITRYPSIN PHENOTYPE 9905 Serum Minimum volume required: 1 mL FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines Note: Alpha-1 Antitryspin Phenotyping Analysis is only available if previously measured alpha-1 antitrypsin was <1.5 g/L or patient is first-degree relative or spouse of known individual. Request must specify previous alpha-1 antitrypsin result and relationship for testing to proceed TAT – 60 days ALPHA–1 ACID GLYCOPROTIEN 9923 Serum Centrifuge and aliquot to transfer tube. GOLD SST TAT – 15 days TEST SPECIFICATION GUIDE - SECTION A Page 7 of 19 CML HealthCare Inc Test Specification Guide 18356 Version: 15.0 21-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. OHIP HLRC TEST NAME ALPHA 2-MACROGLOBULIN CODE 556 SPECIMEN REQUIREMENT Serum Centrifuge Only. VACUTAINER BILL LOC GOLD SST OHIP HLRC LIGHT BLUE $50.00 HLRC GOLD SST OHIP CML GOLD SST OHIP VTF TAT – 20 days ALPHA 2 PLASMIN INHIBITOR 9258 (ALPHA 2 ANTIPLASMIN) Plasma Centrifuge and aliquot Platelet Poor Plasma To transfer tube. Freeze immediately. Store and ship frozen TAT – 25 days ALPHA FETOPROTEIN, ONCOLOGY 691–C Serum Centrifuge only (AFP-ONCOLOGY) Specify if testing is tumor related Diagnosis must be indicated TAT – 1 day ALPHA FETOPROTEIN, PREGNANCY 691–P Serum Centrifuge only (AFP-PREGNANCY) For risk assessment of open neural tube defects Testing is recommended at 16 weeks gestation Completed "Maternal Serum Screen Form” must be provided by ordering Physician. Indicate on the form "AFP ONLY" Results will be reported directly to the requesting Physician by the testing location. TAT – 5 days Refer to ALANINE AMINO TRANSAMINASE ALT (ALANINE AMINO TRANSAMINASE) (SGPT) ALUMINUM 9355 Plasma Centrifuge and aliquot plasma into Aliquot tube. Separate and refrigerate As soon as possible. ROYAL BLUE K2 EDTA TAT – 15 days AMETHOPTERIN Refer to METHOTREXATE (METHOTREXATE) TEST SPECIFICATION GUIDE - SECTION A Page 8 of 19 CML HealthCare Inc Test Specification Guide 18356 Version: 15.0 21-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. $40.00 HLRC TEST NAME CODE AMIKACIN � PEAK 304AP � TROUGH 304AT SPECIMEN REQUIREMENT VACUTAINER Serum PLAIN RED Minimum Volume required: 1 mL Collect 'peak' specimen 30 minutes after IV infusion or 1-2 hours after IM injection by physician BILL LOC OHIP HLRC OHIP HLRC OHIP HLRC $45.00 HLRC Trough before IV / IM injection by physician Record time in hours that have elapsed between last dose and specimen collection. Refrigerate during storage and transport. TAT – 15 days AMIKACIN - RANDOM 304AR Serum Minimum Volume required: 1 mL Specimens submitted as peak or trough are preferred; random orders should be avoided whenever possible. PLAIN RED Store and ship refrigerated TAT – 15 days Refer to METABOLIC SCREEN AMINO ACIDS (METABOLIC SCREEN) AMINO ACIDS-QUANTITATIVE 013 (AMINO ACID FRACTIONATION) (PHENYLALANINE) Plasma GREEN Minimum Volume required: 1 mL - with Heparin Fasting specimen preferred State age of patient, (date of birth), and clinical diagnosis State if patient is on a special diet FREEZE PLASMA AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 30 days AMINO ACIDS-QUANTITATIVE 013U REFER TO METABOLIC SCREEN AMINOGLYCOSIDES Amikacin, Gentamycin or Tobramycin. See individual listings. AMINOPHYLLINE Refer to THEOPHYLLINE (THEOPHYLLINE) (UNIPHYL) AMIODARONE 9417 Plasma Minimum Volume required: 3 mL Draw 1-hour prior to next dose GREEN – with Heparin TAT –20 days TEST SPECIFICATION GUIDE - SECTION A Page 9 of 19 CML HealthCare Inc Test Specification Guide 18356 Version: 15.0 21-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME AMITRIPTYLINE CODE 079AM (ELAVIL) SPECIMEN REQUIREMENT VACUTAINER Serum ROYAL BLUE Minimum Volume required: 2 mL - No Additive Centrifuge and aliquot into serum tube Collect specimen 10–12 hours after last dose Record time in hours that has elapsed between last dose and specimen collection. Refrigerate during storage and transport. BILL LOC OHIP DYN OHIP HLRC OHIP HLRC N/C PHL N/C PHL OHIP CML  Testing Includes Nortriptyline  TAT – 15 days TESTING NO LONGER AVAILABLE AMMONIA (NH3) AMOBARBITAL 9411 (AMYTAL) Serum Minimum Volume required: 3 mL PLAIN RED TAT – 15 days AMOBARBITAL 9412 (AMYTAL) Urine Minimum Volume required: 10 mL random urine Submit in a 90 mL orange cap container TAT – 15 days AMOEBIC ANTIBODY 9078 (E. HISTOLYTICA SEROLOGY ANTIBODY) (ENTAMOEBA HISTOLYTICA ANTIBODY) Do not centrifuge tube PLAIN RED ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days AMOEBIC DETECTION 99999 (E. HISTOLYTICA) Stool Collect two stool samples 1st in ova and parasite container nd 2 in 90 mL container with orange lid ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days Serum - NO LONGER AVAILABLE AMOXAPINE AMPHETAMINE 078AM Urine 10 mL random urine Submit in a blue cap conical tube TAT – 3 days TEST SPECIFICATION GUIDE - SECTION A Page 10 of 19 CML HealthCare Inc Test Specification Guide 18356 Version: 15.0 21-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME AMYLASE CODE 018 (DIASTASE) SPECIMEN REQUIREMENT Serum Centrifuge only VACUTAINER GOLD SST BILL LOC OHIP CML OHIP CML OHIP CML TAT – 1 day AMYLASE 018U (DIASTASE) 24-Hour Urine 10 mL aliquot – submit in a white cap conical tube No preservative State total 24-hour volume on the OHIP Requisition, on the specimen container and in “Notes & Instructions”. Retain a duplicate 90 mL sample in the fridge until test is reported. Testing includes urine creatinine and total volume. TAT – 2 day AMYLASE 018RU (DIASTASE) Urine 10 mL random urine Submit in a white cap conical tube. TAT – 2 days AMYLASE FLUID 018FL Fluid PLAIN RED Minimum volume required: 1 ml This test is NOT available for CCC use. This test is only available at Kennedy Lab for hospital patients. CONTRACT HLRC TAT – 10 days AMYLASE FRACTIONATION 018I (AMYLASE ISOENZYME) Serum Centrifuge only Indicate clinical problem requiring analysis. GOLD SST TAT – 45 to 60 days AMYTAL Refer to AMOBARBITAL (AMOBARBITAL) ANA Refer to NUCLEAR ANTIBODIES (ANF) (ANTI–NUCLEAR ANTIBODY) (CENTROMERE ANTIBODY) (NUCLEAR ANTIBODIES) (SLE ANTIBODIES) ANAFRANIL Refer to CLOMIPRAMINE (CLOMIPRAMINE) ANCA–C (CYTOPLASMIC) Refer to NEUTROPHIL CYTOPLASMIC ANTIBODIES - C (ANTI–NEUTROPHIL CYTOPLASMIC ANTIBODY–C) (NEUTROPHIL CYTOPLASMIC ANTIBODIES) TEST SPECIFICATION GUIDE - SECTION A Page 11 of 19 CML HealthCare Inc Test Specification Guide 18356 Version: 15.0 21-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. $60.00 HLRC TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC OHIP SKH $35.00 HLRC GOLD SST OHIP CML 3 LAVENDERS OHIP CML LAVENDER OHIP CML Refer to NEUTROPHIL CYTOPLASMIC ANTIBODIES - P ANCA–p (PERINUCLEAR) (ANTI–NEUTROPHIL CYTOPLASMIC ANTIBODIES–P) Refer to TESTOSTERONE ANDROGEN TESTICULAR (TESTOSTERONE) ANDROSTENEDIONE 305 Serum PLAIN RED Spin, separate and freeze Store and ship FROZEN TAT – 8 days ANDROSTERONE NO LONGER AVAILABLE ANF Refer to NUCLEAR ANTIBODIES (ANA) (ANTI-NUCLEAR ANTIBODY) (CENTROMERE ANTIBODY) (NUCLEAR ANTIBODIES) (SLE ANTIBODIES) ANGIOTENSIN CONVERTING ENZYME 9245 (ACE) Serum GOLD SST Centrifuge only Assay cannot be performed on a lipemic specimen Refrigerate during storage and transport. TAT – 15 days ANION GAP 053 061 204 226 Serum Centrifuge only Hemolyzed specimens are unacceptable TAT – 1 day NO LONGER AVAILABLE ANTABUSE ANTIBODY IDENTIFICATION HP15 Blood (ANTIBODY ID) (BLOOD GROUP ANTIBODY IDENTIFICATION) DO NOT SEPARATE  Testing Includes titre if positive  TAT – 2 days ANTIBODY SCREEN 482 Blood (INDIRECT COOMBS) (REPEAT PRENATAL ANTIBODY SCREEN) DO NOT SEPARATE TAT – 2 days TEST SPECIFICATION GUIDE - SECTION A Page 12 of 19 CML HealthCare Inc Test Specification Guide 18356 Version: 15.0 21-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC Refer to CARDIOLIPIN ANTOBIDES ANTI–CARDIOLIPIN AB (ANTI PHOSPHOLIPID) (CARDIOLIPIN ANTOBIDES) ANTI-CCP Refer to CYCLIC CITRULLINATED PEPTIDE ANTIBODIES ANTI–dsDNA ANTIBODY Refer to DNA ds ANTIBODIES (ANTI-DNA) (ANTI DSDNA DOUBLE STRANDED AB) (DNA ds ANTIBODIES) Refer to VASOPRESSIN ANTI–DIURETIC HORMONE (ADH) (VASOPRESSIN) Refer to EXTRACTABLE NUCLEAR ANTIBODIES SCREEN ANTI–ENA (ENA ANTIBODY) (EXTRACTABLE NUCLEAR ANTIBODIES SCREEN) ANTI–ENDOMYSIAL ANTIBODY (ENDOMYSIUM ANTIBODIES) Refer to ENDOMYSIUM ANTIBODIES ANTI–EPIDERMAL ANTIBODY Refer to PEMPHIGUS/PEMPHIGOID ANTIBODIES (ANTI-SKIN ANTIBODIES) (PEMPHIGUS/PEMPHIGOID ANTIBODIES) Refer to GLIADIN ANTIBODIES ANTI–GLIADIN ANTIBODY (AGA) (GLIADIN ANTIBODIES) Refer to GLOMERULAR BASEMENT MEMBRANE ANTIBODY ANTI–GLOMERULAR BASEMENT MEMBRANE (GLOMERULAR BASEMENT MEMBRANE ANTIBODY) (ANTI-GAD) Serum Minimum Volume Required: 1ml Centrifuge and aliquot Store and ship frozen TAT - 25 days ANTI–HISTONE Refer to HISTONE ANTIBODIES ANTI-GLUTAMIC ACID DEHYDECARBOXYLASE 9233 GOLD SST (HISTONE ANTIBODIES) ANTI–HBs Refer to HEPATITIS B VIRUS SURFACE ANTIBODY (HEPATITIS B–IMMUNE STATUS) (HEAPTITIS B VIRUS SURFACE ANTIBODY) TEST SPECIFICATION GUIDE - SECTION A Page 13 of 19 CML HealthCare Inc Test Specification Guide 18356 Version: 15.0 21-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. OHIP HLRC TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC Refer to INSULIN ANTIBODIES ANTI–INSULIN (INSULIN ANTIBODIES) Refer to INTRINSIC FACTOR ANTIBODIES ANTI–INTRINSIC FACTOR (INTRINSIC FACTOR ANTIBODIES) Refer to EXTRACTABLE NUCLEAR ANTIBODIES ANTI–JO 1 (JO-1 EXTRACTABLE NUCLEAR ANTIBODIES) Refer to EXTRACTABLE NUCLEAR ANTIBODIES ANTI–LA (SS-B) (SS-B EXTRACTABLE NUCLEAR ANTIBODIES) (LKM ANTIBODY) (ANTI-LIVER KIDNEY MICROSOMAL ANTIBODIES) Serum Centrifuge only Store and ship refrigerated TAT – 14 days ANTI-MICROSOMAL ANTIBODIES Refer to THYROID MICROSOMAL ANTIBODIES ANTI-LKM ANTIBODY 9237 GOLD SST OHIP HLRC (ATA) (ATMA) (ANTI-THYROID ANTIBODY) (MICROSOMAL ANTIBODIES) (MICROSOMAL THYROID ANTIBODIES) (THYROGLOBULIN ANTIBODIES) (THYROID ANTIBODIES) ANTI–MITOCHONDRIAL ANTIBODY Refer to MITOCHONDRIAL ANTIBODIES (ASMA) (ANTI-SMOOTH MUSCLE ANTIBODIES) (MITOCHONDRIAL ANTIBODIES) (SMA) (SMOOTH MUSCLE ANTIBODY) ANTI-MULLERIAN HORMONE 9590 (AMH) (ANTI OVARIAN HORMONE) (MIS) Serum Minium volume required: 1 mL Centrifuge and aliquot Store and ship frozen. PLAIN RED TAT – 6 days ANTI–NEUTROPHIL CYTOPLASMIC ANTIBODIES - C Refer to NEUTROPHIL CYTOPLASMIC ANTIBODIES - C (c-ANCA - CYTOPLASMIC) ANTI–NEUTROPHIL CYTOPLASMIC ANTIBODIES - P Refer to NEUTROPHIL CYTOPLASMIC ANTOBIDIES - P (p-ANCA – PERINUCLEAR) ANTI–NUCLEAR ANTIBODY Refer to NUCLEAR ANTIBODIES (ANA) (ANF) (CENTROMERE ANTIBODIES) (NUCLEAR ANTIBODIES) (SLE ANTIBODIES) TEST SPECIFICATION GUIDE - SECTION A Page 14 of 19 CML HealthCare Inc Test Specification Guide 18356 Version: 15.0 21-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. $62.00 LL TEST NAME CODE ANTI–PANCREATIC ISLET CELLS ANTIBODY SPECIMEN REQUIREMENT VACUTAINER Refer to PANCREATIC ISLET CELL ANTIBODIES (PANCREATIC ISLET CELL ANTIBODIES) ANTI–PARIETAL CELL ANTIBODIES Refer to PARIETAL CELL ANTIBODIES (PARIETAL CELL ANTIBODIES) ANTI–PHOSPHOLIPID Refer to CARDIOLIPIN ANTIBODIES (ANTI-CARDIOLIPIN) (CARDIOLIPIN ANTIBODIES) ANTI-PLATELET ANTIBODIES Refer to PLATELET ANTIBODY SCREEN (PLATELET ASSOCIATED ANTIBODIES) (PLATELET ANTIBODY SCREEN) ANTI–RETICULIN ANTIBODY Refer to RETICULIN ANTIBODIES (ANTI-RETICULIN AB) (RETICULIN ANTIBODIES) ANTI–RNP Refer to EXTRACTABLE NUCLEAR ANTIBODIES ANTI–RO Refer to EXTRACTABLE NUCLEAR ANTIBODIES (SS–A) ANTI–SCL–70 Refer to EXTRACTABLE NUCLEAR ANTIBODIES (Scl-70 ANTIBODIES) (SCLERODERMAL ANTIBODY) ANTI–SM Refer to EXTRACTABLE NUCLEAR ANTIBODIES SCREEN (ANTI–SMITH) ANTI–SMOOTH MUSCLE ANTIBODIES Refer to MITOCHONDRIAL ANTIBODIES (ANTI-MITOCHONDRIAL ANTIBODIES) (ASMA) (MITOCHONDRIAL ANTIBODIES) (SMA) (SMOOTH MUSCLE ANTIBODY) ANTI–SPERM ANTIBODIES Refer to SPERM ANTIBODIES (SPERM ANTIBODIES) ANTI–STREPTOCCAL HYALURONIDASE ANTIBODY TEST NO LONGER AVAILABLE (ASH) ANTI–STREPTOLYSIN O TITRE Refer to STREPTOLYSIN O ANTIBODY (ASOT) (STREPTOLYSIN O ANTIBODY) TEST SPECIFICATION GUIDE - SECTION A Page 15 of 19 CML HealthCare Inc Test Specification Guide 18356 Version: 15.0 21-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. BILL LOC TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC Refer to THYROID MICROSOMAL ANTIBODIES ANTI-THYROID ANTIBODY (ATA) (ATMA) (ANTI-THYROID ANTIBODY) (MICROSOMAL ANTIBODIES) (THYROID MICROSOMAL ANTIBODIES) (THYROGLOBULIN ANTIBODIES) (THYROID ANTIBODIES) ANTI–THROMBIN III 373 (ANTI-THROMBIN ASSAY) Plasma LIGHT BLUE Minimum Volume required: 1 mL Specify if for functional or immunological testing Patient should not be on anticoagulant therapy OHIP HLRC FREEZE PLASMA AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines TAT – 20 days Refer to THYROID PEROXIDASE ANTIBODY ANTI-THYROID PEROXIDASE (TPO AB) (THYROID PEROXIDASE ANTIBODY) Refer to ACTIVATED PROTEIN C RESISTANCE APCR (ACTIVATED PROTEIN C RESISTANCE) Serum Submit Monday – Wednesday ONLY Patient must fast 12 hours Separate serum from red cells within 4 hours APOLIPOPROTEIN 9857 9858 PLAIN RED Specify: A1 – 1 mL B – 1 mL C2 ACTIVATION – NO LONGER AVAILABLE HLRC $35.00 $35.00 Refrigerate during storage and transport. TAT – 30 days APOLIPOPROTEIN-E (-E GENOTYPE) 9862 Whole Blood Submit Monday – Wednesday ONLY Store and send refrigerated LAVENDER TAT – 30 days APO PROTEIN a Refer to LIPOPROTEIN a (LIPOPROTEIN a) TEST SPECIFICATION GUIDE - SECTION A Page 16 of 19 CML HealthCare Inc Test Specification Guide 18356 Version: 15.0 21-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. $55.00 HLRC TEST NAME ARBOVIRUS ANTIBODIES CODE 9080 SPECIMEN REQUIREMENT VACUTAINER Do not centrifuge tube PLAIN RED BILL N/C LOC PHL PHL recommends both acute and convalescent samples be taken 2 weeks apart. ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days ARSENIC- BLOOD 9279 Whole Blood Do not centrifuge. Send entire tube. ROYAL BLUE (K2EDTA) $70.00 HLRC TAT – 20 days ARSENIC- HAIR 9908 Hair Clip hair close to the nape of the neck from 6-8 different locations – 0.2 gm hair required (approximately 2 teaspoons full) Bleaches and dyes may interfere Submit in a 90 mL container $70.00 HLRC $70.00 HLRC $70.00 HLRC $70.00 HLRC TAT – 45 days ARSENIC- NAIL 9909 Nails Clip nails from all fingers Patient must remove nail polish prior to collection Submit in a 90 mL container TAT – 45 days ARSENIC- 24 HOUR URINE 9187 24-Hour Urine 50 mL aliquot – submit in a 90 mL white cap container Avoid seafood consumption 5 days prior to collection. Inorganic arsenic will be performed if total is elevated. State total 24-hour volume on the OHIP Requisition, on the specimen container and in “Notes & Instructions” Retain a duplicate 50 mL sample in the fridge until test is reported. TAT – 10 to 60 days ARSENIC- RANDOM URINE 9186 Urine 15 mL random urine Submit in a 90 mL orange cap container Avoid seafood consumption 5 days prior to collection. Inorganic arsenic will be performed if total is elevated. TAT – 30 days TEST SPECIFICATION GUIDE - SECTION A Page 17 of 19 CML HealthCare Inc Test Specification Guide 18356 Version: 15.0 21-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE ARTHROPOD IDENTIFICATION 9028 (BUGS) (LICE) SPECIMEN REQUIREMENT VACUTAINER Send entire specimen in container BILL N/C LOC PHL ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days ARYLSULFATASE A – WBC (HOSP ONLY) 9383 Whole Blood GREEN Min volume required: 7ml - Heparinized Test not available for CCC use This test is only for use at the Kennedy lab for hospital patients Client must call Client Services Urgent Desk between 8:00am and 9:00am to arrange a pickup no later than 10:00am. CONTRACT HICL Do not separate. Maintain at room temp. Immediately ship directly to HICL before 12:00 pm (noon) on the day of collection. Sample must be analysed within 12 hours of collection. Refer to SALICYLATE ASA (ACETYSALICYLIC ACID) (ASPIRIN) (SALICYLATE) ASCORBATE 019 (ASCORBIC ACID) (VITAMIN C) Serum GOLD SST Minimum Volume required: 2 mL Protect from light by aliquoting into amber tube. OHIP DYN OHIP CML FREEZE SERUM AND SEND FROZEN Freeze within 30 minutes of collection Refer to the General Information Page for Specimen Processing & Transport Guidelines TAT – 15 days TEST NO LONGER AVAILABLE ASH (ANTI–STREPTOCCAL HYALURONIDASE AB) Refer to MITOCHONDRIAL ANTIBODIES ASMA (ANTI–SMOOTH MUSCLE ANTIBODY) (ANTI-MITOCHONDRIAL ANTIBODY) (MITOCHONDRIAL ANTIBODIES) (SMA) (SMOOTH MUSCLE ANTIBODY) Refer to STREPTOLYSIN O ANTIBODY ASOT (ANTI–STREPTOLYSIN O TITRE) (STREPTOLYSIN O ANTIBODY) ASPARTATE AMINO TRANSAMINASE (AST) (SGOT) 222 Serum GOLD SST Centrifuge only TAT – 1 day TEST SPECIFICATION GUIDE - SECTION A Page 18 of 19 CML HealthCare Inc Test Specification Guide 18356 Version: 15.0 21-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME ASPERGILLUS ANTIBODY CODE 9033 SPECIMEN REQUIREMENT Do not centrifuge VACUTAINER PLAIN RED BILL N/C LOC PHL ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 30 days Refer to SALICYLATE ASPIRIN (ACETYSALICYLIC ACID) (ASA) (SALICYLATE) Refer to ASPARTATE AMINO TRANSAMINASE AST (ASPARTATE AMINO TRANSAMINASE) (SGOT) Refer to THYROID MICROSOMAL ANTOBIDIES ATA (ATMA) (ANTI-THYROID ANTIBODY) (MICROSOMAL ANTIBODIES) (THYROGLOBULIN ANTIBODIES) (THYROID MICROSOMAL ANTIBODIES) (THYROID ANTIBODIES) Refer to LORAZEPAM ATIVAN (LORAZEPAM) Refer to NORTRIPTYLINE AVENTYL (NORTRIPTYLINE) AVIAN PRECIPITINS (BIRD FANCIER’S DISEASE) 9034 Serum Centrifuge, separate into transfer tube and refrigerate. PLAIN RED Billed per each allergen. Budgie & Pidgeon done routinely: goose, chicken, duck, canary, cockatiel, parrot, turkey must be requested if clinically indicated. TAT – 18 days TEST SPECIFICATION GUIDE - SECTION A Page 19 of 19 CML HealthCare Inc Test Specification Guide 18356 Version: 15.0 21-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. $35.00 HLRC TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC Refer to CAROTENE B–CAROTENE (CAROTENE) B-TYPE NATRIURETIC PEPTIDE Refer to N-TERMINAL PROBRAIN NATRIURETIC PEPTIDE B12 Refer to COBALAMINS (VITAMIN B12) (COBALAMINS) Refer to BETA 2-MICROGLOBULIN B2 MICROGLOBULIN (BETA 2-MICROGLOBULIN) (MICROGLOBULIN) BARBITURATES SCREEN 026U Urine 10 mL random urine Submit in a blue cap conical tube OHIP CML N/C PHL TAT – 2 days BARTONELLA ANTIBODY 9011 Do not centrifuge tube PLAIN RED (CAT SCRATCH DISEASE) ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 3 weeks BCR-ABL (QUANTITATIVE PCR) (BCR/ABL) 9382 Whole Blood LAVENDER CONTRACT HLRC Min volume required: 10ml Test is NOT available for CCC use. Test is only for use at Kennedy Lab for Hospital patients. Download requisition at http://lrc.hrlmp.ca/uploaded/R_MolecularOncology.pdf Form must be completed and submitted along with specimen and req. Ship within 24 hours. If required store overnight at 4°C TAT – 33 days BENADRYL Refer to DIPHENHYDRAMINE (DIPHENHYDRAMINE) BENCE–JONES PROTEIN Refer to PROTEIN ANALYSIS – BENCE JONES PROTEIN (IEP – RANDOM URINE) (IMMUNOELECTROPHORESIS) (HEAVY AND LIGHT CHAINS) BENZENE (PHENOL) TEST NO LONGER AVAILABLE TEST SPECIFICATION GUIDE - SECTION B Page 1 of 6 CML HealthCare Inc Test Specification Guide 17525 Version 5.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME BENZODIAZEPINE SCREEN CODE 078BE SPECIMEN REQUIREMENT VACUTAINER Urine 10 mL random urine Submit in a blue cap conical tube BILL OHIP LOC CML TAT – 2 days BETA 2 GLYCOPROTIEN I IgG 9268 Serum PLAIN RED OHIP HLRC GOLD SST $50.00 HLRC (BETA-2-GP-I IgG Centrifuge and aliquot to transfer tube. Store and ship frozen. TAT – 33 days BETA 2 MICROGLOBULIN 9101 (B2 MICROGLOBULIN) (MICROGLOBULIN) Serum Centrifuge only Refrigerate during storage and transport. TAT – 25 days BETA 2 MICROGLOBULIN 9101RU (B2 MICROGLOBULIN) (MICROGLOBULIN) Urine 10 mL random urine – Submit in a 90 mL orange cap container $50.00 HLRC Ask patient to void (discard), then drink a glass of water collect urine for submission one hour later FREEZE URINE AND SEND FROZEN TAT – 25 days Refer to CHORIOGONADOTROPIN BETA–hCG (BHCG) (HUMAN CHORIONIC GONADOTROPIN) (CHORIOGONADOTROPIN) BETA HYDROXYBUTYRATE 9248 (BHBA) (3HBA) Serum Centrifuge, separate into transfer tube. Freeze immediately. Store and send frozen. GOLD SST OHIP HLRC OHIP HLRC TAT – 6 days BETA TRANSFERRIN 9352 Fluid STERILE CONTAINER Accept any container/tube received. Indicate source. Store and send frozen. Analysis includes Beta 1 Transferrin and Beta 2 Transferrin TAT – 14 days BICARBONATE Refer to CARBON DIOXIDE (CO 2) (CARBON DIOXIDE) TEST SPECIFICATION GUIDE - SECTION B Page 2 of 6 CML HealthCare Inc Test Specification Guide 17525 Version 5.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE SPECIMEN REQUIREMENT 9307 Serum Minimum Volume required: 1 mL BILE ACID VACUTAINER GOLD SST BILL LOC $40.00 HLRC OHIP CML GOLD SST OHIP CML GOLD SST OHIP CML GOLD SST OHIP CML PLAIN RED N/C PHL 12 hour fast required FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 30 days Refer to TESTOSTERONE BIO AVAILABLE BIO AVAILABLE TESTOSTERONE (TESTOSTERONE BIO AVAILABLE) BILIRUBIN 254–6 (BILE) Urine 10 mL random urine Submit in a yellow cap conical tube TAT – 1 day BILIRUBIN, DIRECT 031 (CONJUGATED BILIRUBIN) (BILIRUBIN GLUCURONIDATED) Serum Centrifuge only TAT – 1 day BILIRUBIN, INDIRECT (UNCONJUGATED BILIRUBIN) (BILIRUBIN NON-GLUCURONIDATED) 030 031 Serum Centrifuge only State test in “Notes & Instructions”. TAT – 1 day BILIRUBIN, TOTAL 030 Serum Centrifuge only TAT – 1 day Refer to QUINIDINE BIQUIN (Q-10 METABOLITE) (QUINIDINE) Refer to AVIAN PRECIPITINS BIRD FANCIERS’ DISEASE BLASTOMYCES ANTIBODY (BLASTOMYCOSIS ANTIBODY DERMATITIDIS) 9037 Do not centrifuge tube ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 30 days TEST SPECIFICATION GUIDE - SECTION B Page 3 of 6 CML HealthCare Inc Test Specification Guide 17525 Version 5.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME BLASTOMYCOSIS CULTURE DERMATITIDIS CODE 9038 SPECIMEN REQUIREMENT VACUTAINER Culture Skin scraping BILL LOC N/C PHL LAVENDER OHIP CML LAVENDER OHIP CML LAVENDER OHIP CML OHIP CML ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 30 days BLEEDING TIME, DUKE METHOD TEST NO LONGER AVAILABLE BLEEDING TIME, IVY METHOD NO LONGER AVAILABLE BLOOD CULTURE Refer to CULTURE & SENSITIVITY - BLOOD BLOOD FILM EXAMINATION Refer to COMPLETE BLOOD COUNT BLOOD GROUP 490 (ABO, Rh(D) (ABO & TYPE) (BLOOD GROUP) (Rh TYPE) Blood DO NOT SEPARATE TAT – 2 days Refer to ANTIBODY IDENTIFICATION BLOOD GROUP ANTIBODY IDENTIFICATION BLOOD GROUP PHENOTYPE 493 (ABO, Rh(D), (GENOTYPE) (GENOTYPE) - Eg ANTIGEN C, E, c, e TAT – 2 days Refer to BLOOD GROUP and Refer to ANTIBODY SCREEN BLOOD GROUP PRENATAL Ab (ABO & Ab SCREEN PRENATAL SCREEN TYPE & SCREEN) BLOOD GROUP ANTIGENS Blood DO NOT SEPARATE 494 - Eg Kell, Duffy, KIDD Blood DO NOT SEPARATE TAT – 2 days BLOOD, QUALITATIVE 254–7 Urine 10 mL random urine Submit in a yellow cap conical tube TAT – 1 day TEST SPECIFICATION GUIDE - SECTION B Page 4 of 6 CML HealthCare Inc Test Specification Guide 17525 Version 5.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME BLOOD PRESSURE MONITORING CODE 995 SPECIMEN REQUIREMENT VACUTAINER Performed at limited sites BILL LOC $75.00 CML N/C PHL N/C PHL N/C PHL TAT – 4 days Refer to BLOOD GROUP BLOOD TYPE (ABO, Rh(D), (ABO & TYPE) (BLOOD GROUP & Rh(D) (Rh TYPE) Refer to N-TERMINAL PROBRAIN NATRIURETIC PEPTIDE BNP (NT-PRO) SERUM TESTING NO LONGER AVAILABLE BORDETELLA PERTUSSIS ANTIBODY (WHOOPING COUGH) BORDETELLA PERTUSSIS 9047 (WHOOPING COUGH) Swab – State source Use the PHL Kit ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 4 days BORRELIA BURGDORFERI ANTIBODY 9045 Do not centrifuge tube PLAIN RED Patient’s history and symptoms are mandatory (LYME DISEASE) ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT –15 days BROAD SPECTRUM DRUG SCREEN Refer to DRUG SCREEN BROAD SPECTRUM BROMIDE NO LONGER AVAILABLE BRUCELLA ANTIBODY 9007 Do not centrifuge tube PLAIN RED ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM  Testing Includes Brucella Abortus and Brucella Melitensis  TAT– 5 days BUGS Refer to ARTHROPOD IDENTIFICATION (ARTHROPODS) (LICE) BUN Refer to UREA (UREA) TEST SPECIFICATION GUIDE - SECTION B Page 5 of 6 CML HealthCare Inc Test Specification Guide 17525 Version 5.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME BUTABARBITAL CODE 9471 SPECIMEN REQUIREMENT VACUTAINER Urine 25 mL random urine Submit in a 90 mL orange cap container TAT – 15 days BUTAZOLIDINE NO LONGER AVAILABLE (PHENYLBUTAZONE) TEST SPECIFICATION GUIDE - SECTION B Page 6 of 6 CML HealthCare Inc Test Specification Guide 17525 Version 5.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. BILL OHIP LOC HLRC TEST NAME CODE C1 ESTERASE INHIBITOR SPECIMEN REQUIREMENT VACUTAINER BILL LOC Refer to COMPLEMENT C1 ESTERASE INHIBITOR (COMPLEMENT C1) C1 ESTERASE INHIBITOR, FUNCTIONAL C1Q IMMUNE COMPLEXES Refer to COMPLEMENT C1 ESTERASE INHIBITIOR, FUNCTIONAL 688 (C1Q COMPLEMENT BINDING ACTIVITY) (C1Q IMMUNE COMPLEXES) (COMPLEMENT C1Q) Serum Minimum Volume required: 1 mL Only performed if CH50 is low GOLD SST OHIP HLRC OHIP CML Separate and freeze within 1-hour of clotting FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 25 days C2 Refer to COMPLEMENT C2 (COMPLEMENT C2) C3 Refer to COMPLEMENT C3 (COMPLEMENT C3) C4 Refer to COMPLEMENT C4 (COMPLEMENT C4) Refer to COMPLEMENT C5 C5 (COMPLEMENT C5) C6 Refer to COMPLEMENT C6 (COMPLEMENT C6) CD3, CD4, CD8 Refer to LYMPHOCYTE MARKER T CELLS ONLY (LYMPHOCYTE MARKER-T CELL ONLY) (T CELL LYMPHOCYTE MARKER ONLY) C–PEPTIDE 346 Plasma Minimum Volume required: 2 mL Fasting specimen required GREEN –with Heparin FREEZE PLASMA AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 5 days C–REACTIVE PROTEIN (CRP) (C–REACTIVE PROTEIN) SEE C-REACTIVE PROTEIN HIGH SENSITIVITY TEST SPECIFICATION GUIDE - SECTION C Page 1 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME C–REACTIVE PROTEIN HIGH SENSIVITY CODE 665HS SPECIMEN REQUIREMENT VACUTAINER BILL LOC GOLD SST OHIP CML GOLD SST $60.00 HLRC GOLD SST $35.00 CML GOLD SST $35.00 HLRC PLAIN RED $55.00 HLRC LAVENDER $40.00 HLRC $40.00 HLRC $40.00 HLRC Serum Centrifuge only (CRP HIGH SENSIVITY) TAT – 1 day C–TELOPEPTIDE 9164 Serum Minimum volume required: 1 ml Fasting specimen preferred FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 20 days CA 125 9389 (OV 125) (CANCER ANTIGEN 125) Serum Centrifuge only Should not to be used as a diagnostic screening test. TAT – 5 days CA 15 – 3, Breast 9912 (CANCER ANTIGEN 15-3) (CARBOHYDRATE ANTIGEN 15-3) Serum Centrifuge and aliquot to transfer tube. Freeze serum and send frozen TAT – 10 days CA 19– 9, Pancreas 9913 (CANCER ANTIGEN 19-9) (CARBOHYDRATE ANTIGEN 19-9) Serum Centrifuge and aliquot to transfer tube. Store and ship refrigerated. TAT – 4 days CADMIUM 9680 Blood Do not open tube TAT – 21 days CADMIUM SCREEN 9680U 24 Hour Urine 50 mL aliquot – submit in a white cap 90 mL container State total 24-hour volume on the OHIP Requisition, on the specimen container and in “Notes & Instructions” . Retain a duplicate 50 mL sample in the fridge until test is reported. TAT – 15 days CADMIUM SCREEN 9680R Urine 50 mL aliquot random urine Submit in a white cap 90 mL container TAT – 21 days TEST SPECIFICATION GUIDE - SECTION C Page 2 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CAFFEINE CODE 9129 (CAFFEINE- QUANTITATIVE) SPECIMEN REQUIREMENT VACUTAINER BILL LOC $60.00 HLRC GOLD SST $50.00 CML GOLD SST OHIP CML Serum PLAIN RED Minimum Volume required: 1 mL Collect 10 – 12 hours after last dose Record time in hours that have elapsed between last dose and specimen collection. TAT – 15 days CALCIDIOL (UNINSURED) 9802 (25 HYDROXY VITAMIN D) (VITAMIN D) Serum Minimum volume required: 2 mL Centrifuge SST Store and ship refrigerated No pour-off required TAT – 2 days CALCIDIOL (INSURED) 606 (25 HYDROXY VITAMIN D) (VITAMIN D) Serum Minimum volume required: 2 mL Centrifuge SST Store and ship refrigerated No pour-off required Patient must meet eligibility criteria for insurable Calcidiol testing TAT – 2 days CALCITONIN 301 Serum Minimum Volume required: 3 mL Fasting sample required. Centrifuge, separate, freeze within 30-minutes of clotting. GOLD SST OHIP DYN GOLD SST OHIP HLRC GOLD SST OHIP CML FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 30 days CALCITRIOL 605 (VITAMIN D) (1,25 DIHYDROXY VITAMIN D) Serum Minimum volume required: 2 mL Centrifuge and pour-off Store and send refrigerated TAT – 14 days CALCIUM 045 Serum Centrifuge only TAT – 1 day TEST SPECIFICATION GUIDE - SECTION C Page 3 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CALCIUM, CORRECTED CODE 045C SPECIMEN REQUIREMENT VACUTAINER Serum GOLD SST Centrifuge only Testing includes serum calcium and albumin. BILL LOC OHIP CML OHIP CML OHIP CML OHIP CML State test in “Notes & Instructions” and on the OHIP requisition. TAT – 1 day CALCIUM, IONIZED 046–1 Serum GOLD SST Allow specimen to clot for 30 minutes Centrifuge only Do not remove tube stopper Test result is invalid if specimen is exposed to air TAT – 2 days CALCIUM, URINE 045U 24 Hour Urine 10 mL aliquot – submit in a white cap conical tube State total 24-hour volume on the OHIP Requisition, on the specimen container and in “Notes & Instructions”. Testing includes urine creatinine Retain a duplicate 90 mL sample in the fridge until test is reported. TAT – 2 days CALCIUM, URINE 045RU Urine 10 mL random urine Submit in a white cap conical tube TAT – 2 days CALCULUS ANALYSIS 047 Submit entire specimen Indicate source Transportation: follow irretrievable sample procedure. Submit unpreserved stone in clean labelled container. TAT – 30 days OHIP HLRC 9293 Sterile Container Collect undiluted feces in a clean, dry, sterile, leakproof container. Do not add fixative or preservative. Store and ship frozen. $110.00 LL (STONE ANALYSIS) CALPROTECTIN, STOOL (FECAL CALPROTECTIN) TAT- 15 days CAMPYLOBACTER Refer to CULTURE & SENSITIVITY - STOOL (STOOL CULTURE) CANCER ANTIGEN 15-3 Refer to CA 15-3 (CA 15-3, Breast) (CARBOHYDRATE ANTIGEN 15-3) TEST SPECIFICATION GUIDE - SECTION C Page 4 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE SPECIMEN REQUIREMENT CANCER ANTIGEN 19-9 (CA 19– 9, Pancreas) (CARBOHYDRATE ANTIGEN 19-9) Refer to CA 19-9 CANDIDA TITRE TEST NO LONGER AVAILABLE CANNABINOIDS SCREEN 078M (CANNABIS) (MARIJUANA) (TETRAHYDROCANNABINOIDS) (THC) CARBAMAZEPINE VACUTAINER BILL LOC OHIP CML OHIP CML GOLD SST OHIP CML GREEN -with Heparin OHIP LL Urine 10 mL random urine Submit in a blue cap conical tube TAT – 2 days 040 (TEGRETOL) Serum PLAIN RED Minimum Volume required: 2 mL Collect specimen 10 – 12 hours after last dose Record time in hours that have elapsed between last dose and specimen collection. TAT – 1 day CARBOHYDRATE ANTIGEN 15-3 Refer to CA 15-3 (CA 15-3, Breast) (CANCER ANTIGEN 15-3) CARBOHYDRATE ANTIGEN 19-9 CARBON DIOXIDE Refer to CA 19-9 061 (BICARBONATE) (CO2) Serum Centrifuge only Do not remove tube stopper. TAT – 1 day CARBOXYHEMOGLOBIN 060 Blood (CARBON MONOXIDE) DO NOT OPEN TUBE Refrigerate during storage and transport. TAT – 14 day TEST SPECIFICATION GUIDE - SECTION C Page 5 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CARCINOEMBRYONIC ANTIGEN CODE 690 SPECIMEN REQUIREMENT VACUTAINER BILL GOLD SST OHIP CML $35.00 CML Serum – Min volume: 1ml Centrifuge and aliquot to transfer tube. LOC (CEA) A CEA Requisition Form completed and signed by the physician must accompany sample. KEEP TOGETHER IN A PRIORITY BAG Four weeks (28 days) must elapse between test requests. Testing is covered by OHIP for a patient who is: (a) being treated for metastatic breast cancer (b) receiving adjuvant therapy for resected colorectal cancer (c) being treated for metastatic disease FORM AVAILABLE ON CML WEBSITE TAT – 4 days CARCINOEMBRYONIC ANTIGEN 9328 (CEA) Serum – Min Volume 1ml Centrifuge and aliquot into transfer tube. Store and ship refrigerated. GOLD SST A CEA Requisition Form completed and signed by the physician must accompany sample. KEEP TOGETHER IN A PRIORITY BAG NOTE: to be used when four weeks have NOT elapsed between CEA test requests OR when the patient does not meet the above criteria. FORM AVAILABLE ON CML WEBSITE TAT – 4 days CARDIOLIPIN ANTIBODIES IgG AND IgM 9109 (ANTI–CARDIOLIPIN AB) (ANTI PHOSPHOLIPIN) Serum Minimum volume required: 2 mL PLAIN RED $55.00 HLRC GOLD SST $60.00 HLRC GOLD SST OHIP HLRC FREEZE SERUM AND SEND FROZEN Includes ACL IgG and ACL IgM Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 15 days CARNITINE, FREE / TOTAL 9710 Serum Minimum Volume required: 1 mL Provide date of birth, gender, clinical history. FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 20 days CAROTENE (B–CAROTENE) 049 Serum Minimum Volume required: 4 mL FREEZE SERUM AND SEND FROZEN Protect from light by transferring serum into an amber transport tube. TAT – 20 days TEST SPECIFICATION GUIDE - SECTION C Page 6 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE CAT SCRATCH FEVER ANTIBODY SPECIMEN REQUIREMENT VACUTAINER BILL LAVENDER OHIP LOC Refer to BARTONELLA ANTIBODY (BARTONELLA ANTIBODY) CATECHOLAMINES 9527 (EPINEPHRINES) (NOREPINEPHRINES) CATECHOLAMINES, FRACTIONATED Plasma HLRC Patient must be supine for at least 15 minutes prior to & during specimen collection. Collect after overnight fast (water and noncaffeinated drinks permissable). Provide list of medications. Specimen should be kept cold and spun in refrigerated centrifuge ASAP, within 60 minutes of collection. Freeze immediately. Store and send frozen. If the specimen thaws, it is unsuitable for analysis. TAT – 14 Days 051 24-Hour Urine 50 mL aliquot – submit in a white cap 90 mL container Do not add acid; ph will be adjusted in Biochemistry Dept. Do not use this sample for any other test. OHIP DYN State total 24-hour volume on the OHIP Requisition, on the specimen container and in “Notes & Instructions” . Refrigerate during storage and transport. Retain a duplicate 50 mL aliquot with preservative, in the fridge until test is reported.  Testing Includes Epinephrine & Norepinephrine, Dopamine  To be avoided for 48 hours before collection: ASA, Chloralhydrate, coffee, cola drinks, dopamine, erythromycin, methyldopa, niacin, phenothiazines, quinidine, quinine, riboflavin, smoking, tea, tetracycline, vitamin B. To be avoided for 72 hours before collection: avacados, bananas, chocolate, eggplant, fruit and juices, hypertensive drugs (esp. Aldomet), pineapple, plums, Tylenol (acetaminophen), walnuts. TAT – 30 days CATECHOLAMINES, TOTAL TOTAL NO LONGER AVAILABLE - refer to CATECHOLAMINES, FRACTIONATED CBC Refer to COMPLETE BLOOD COUNT CCP ANTIBODY Refer to CYCLIC CITRULLINATED PEPTIDE ANTIBODIES CEA Refer to CARCINOEMBRYONIC ANTIGEN (CARCINOEMBRYONIC ANTIGEN) TEST SPECIFICATION GUIDE - SECTION C Page 7 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE CELIAC DISEASE PANEL 9951 SPECIMEN REQUIREMENT Serum Centrifuge only VACUTAINER GOLD SST BILL LOC $120.00 HLRC OHIP CML  Testing Includes Deamidated Gliadin Peptide IgG And Tissue Transglutaminase IgA Antibodies  TAT – 15 days CELONTIN Refer to METHSUXIMIDE (METHSUXIMIDE) CENTROMERE ANTIBODIES Refer to NUCLEAR ANTIBODIES (ANA) (ANF) (NUCLEAR ANTIBODIES) (SLE ANTIBODY) CERULOPLASMIN 052 Serum Centrifuge only GOLD SST TAT – 1 day CH50 Refer to COMPLEMENT TOTAL CH50 (COMPLEMENT HEMOLYTIC) (HEMOLYTIC COMPLEMENT FIXATION) (COMPLEMENT TOTAL CH50) CHLAMYDIA – URINE APTIMA URINE ‐ PHL 9166 VIPER TUBE:     6932 TAT ‐ 15 Days                                                        N/C                                    CML Note: Send sample to PHL ONLY IF specifically requested by the physician.  REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM. TAT ‐ 3 Days                                                          OHIP                                  CML Patient should not have urinated in the last hour. Collect the first part of the urine stream to ensure a high organism count. Void 20-30 mL (larger urine volume dilutions may result in false negative results) into one container for Chlamydia and then collect urine for any other tests ordered in a second container. Staff transfer 2mL with provided pipette to VIPER Urine Specimen Collection Kit (BD PROBETEC QX UPT). Note: Submission will also be tested and reported for Neisseria Gonorrhoeae. CHLAMYDIA - SWAB APTIMA SWAB ‐ PHL 9083 TAT ‐ 15 Days                                                             N/C                                    CML Note: Send sample to PHL ONLY IF specifically requested by the physician.  REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM. VIPER SWAB:      6930 TAT ‐ 3 Days                                                              OHIP                                  CML Swab – state source: cervical/vaginal (for female); urethral (for male) Note: Submission will also be tested and reported for Neisseria Gonorrhoeae Swab must be submitted in BD PROBETEC QX COLLECTION KIT transport tube with black cap. Store and transport at room temperature. TEST SPECIFICATION GUIDE - SECTION C Page 8 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE CHLAMYDIA PSITTACI ANTIBODY SPECIMEN REQUIREMENT VACUTAINER BILL LOC SEROLOGY TESTING NO LONGER AVAILABLE. (PSITTACOSIS ANTIBODY) CHLORDIAZEPOXIDE 9467 Serum RED TOP Minimum Volume required: 2 mL Collect specimen 10 – 12 hours after last dose Record time in hours that have elapsed between last dose and specimen collection. TAT – 15 days OHIP HLRC 053 Serum Centrifuge only OHIP CML OHIP CML 24 Hour Urine OHIP 10 mL aliquot – submit in a white cap conical tube No preservative State total 24-hour volume on the OHIP Requisition, on the specimen container and in “Notes & Instructions” . Retain a duplicate 50 mL sample in the fridge until test is reported. Includes urine creatinine and total volume CML (LIBRIUM) CHLORIDE GOLD SST TAT – 1 day CHLORIDE, URINE 053RU Urine 10 mL random urine Submit in a white cap conical tube TAT – 2 days CHLORIDE, 24 HOUR URINE 053U TAT – 2 days CHLORPROMAZINE (LARGACTIL) 9496 Serum PLAIN RED Minimum Volume required: 2 mL Collect trough specimen prior to next dose. Record time in hours that have elapsed between last dose and specimen collection. OHIP TAT – 15 days CHOLESTEROL, FASTING Refer to LIPID ASSESSMENT, FASTING CHOLESTEROL, RANDOM Refer to LIPID ASSESSMENT, FASTING CHOLESTEROL IN HDL Refer to LIPID ASSESSMENT, FASTING/LIPID ASSESSMENT, NON FASTING CHOLESTEROL IN LDL (LDL CHOLESTEROL) Refer to LIPID ASSESSMENT, FASTING/LIPID ASSESSMENT, NON FASTING TEST SPECIFICATION GUIDE - SECTION C Page 9 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. HLRC TEST NAME CHOLINESTERASE, TOTAL CODE 057 SPECIMEN REQUIREMENT Serum Minimum volume required: 2 mL Centrifuge and aliquot into transfer tube Store and ship frozen. VACUTAINER BILL LOC GOLD SST OHIP HLRC GOLD SST OHIP HLRC GOLD SST OHIP CML GOLD SST OHIP CML $60.00 HLRC If patient has had recent surgery, please wait 24 hours post-surgery before blood collection. TAT – 10 days CHOLINESTERASE, PHENOTYPE 058 (DIBUCAINE INHIBITION TEST) (PSEUDO-CHOLINESTERASE) Serum Minimum volume required: 2 mL Centrifuge and aliquot into transfer tube Store and ship frozen. If patient has had recent surgery, please wait 24 hours post-surgery before blood collection. TAT – 11 days CHOLINESTERASE, RBC (ACETYL CHOLINESTERASE) CHORIO GONADOTROPIN, ONCOLOGY Refer to ACETYL CHOLINESTERASE 318–C (BETA HCG- for ONCOLOGY) Serum Centrifuge only Label tube “hCG for Oncology”. TAT – 1 day CHORIO GONADOTROPIN, PREGNANCY 318 Serum Centrifuge only (BETA HCG- for PREGNANCY) TAT – 1 day CHORIO GONADOTROPIN SCREEN Refer to PREGNANCY TEST (PREGNANCY TEST) CHROMIUM 9232 Urine 50 mL random urine Submit in a 90 mL orange cap container. TAT – 15 days CHROMIUM 9249 Plasma ROYAL BLUE (K2EDTA) Min volume: 3ml Separate plasma within 30 min into metal-free polypropylene tube. Do not use gel-separator collection tubes. $60.00 HLRC TAT – 20 days CHROMOGRANIN A 9244 Plasma (EDTA) 2 x 1ml aliquots Store and ship frozen LAVENDER TAT – 15 days TEST SPECIFICATION GUIDE - SECTION C Page 10 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. $90.00 HLRC TEST NAME CODE CHROMOSOME ANALYSIS SPECIMEN REQUIREMENT VACUTAINER BILL LOC OHIP HLRC OHIP HLRC OHIP DYN Refer to KARYOTYPING (KARYOTYPING) CIRCULATING ANTICOAGULANT Refer to LUPUS ANTICOAGULANT (LUPUS ANTICOAGULANT) (NON–SPECIFIC COAGULATION INHIBITORS) CITRATE 9323 24-Hour Urine 2 X 10 mL – submit in white cap conical tubes Do NOT add acid; pH will be adjusted in Biochemistry Dept. State 24-hour volume Retain a duplicate 50 mL sample in the fridge until test is reported. TAT – 15 days CK Refer to CREATINE KINASE (CPK) (CREATINE PHOSPHOKINASE) (CREATINE KINASE) CK–MB Refer to CREATINE KINASE- MB (CK-2 MB) (CREATINE PHOSPHOKINASE-MB) (CREATINE KINASE-MB) CK ELECTROPHORESIS Refer to CREATINE KINASE FRACTIONATION (CK ISOENZYMES) (CK FRACTIONATION) (CREATINE KINASE FRACTIONATION) CLOBAZAM 9116 (FRISIUM) (DESMETHYL CLOBAZAM) Serum or heparinized plasma PLAIN RED Minimum Volume required: 2 mL Morning sample taken prior to the drug dose. Do not use gel separator tubes. Promptly centrifuge and separate serum/plasma into a plastic transfer tube separate serum and transfer to plastic tube. Also includes Desmethyl Clobazam Sodium or Lithium heparinized plasma is acceptable. o Store and ship at 4 - 8 C TAT – 10 days CLOMIPRAMINE (ANAFRANIL) 079E Serum ROYAL BLUE Minimum Volume required: 2 mL - no additive Centrifuge and aliquot into serum tube Collect specimen 10–12 hours after last dose Do not use SST Record time in hours that have elapsed between last dose and specimen collection. Refrigerate during storage and transport. ● Includes Desmethyclomipramine ● TAT – 20 days TEST SPECIFICATION GUIDE - SECTION C Page 11 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CLONAZEPAM CODE 9536 (RIVOTRIL) SPECIMEN REQUIREMENT VACUTAINER BILL LOC PLAIN RED OHIP HLRC N/C PHL Serum Minimum Volume required: 3 mL Centrifuge and aliquot into serum tube Collect trough specimen immediately prior to next dose. FREEZE SERUM AND SEND FROZEN TAT – 10 days CLOSTRIDIUM DIFFICILE CULTURE AND TOXIN STUDIES 9074 Stool Submit approximately 15 mL of stool in sterile 90 mL orange cap container. If sample will not be sent to PHL within 48 hours, it must be frozen. Specify culture and / or toxin studies ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM Specimen storage and transportation at 2-8 °C, or frozen if time in transit greater than 48 hours. TAT – 5 to 10 days CLOT RETRACTION TEST NO LONGER AVAILABLE CLOTTING TIME TEST NO LONGER AVAILABLE CLOZAPINE 9916 (CLOZARIL) (DESMETHYLCLOZAPINE) (NORCLOZAPINE) Plasma Minimum Volume required: 2 mL Collect trough specimen immediately prior to next dose. LAVENDER OHIP GOLD SST OHIP HLRC FREEZE PLASMA AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 20 days CMV Refer to CYTOMEGALOVIRUS ANTIBODY (CYTOMEGALOVIRUS ANTIBODY) CMV ISOLATION Refer to CYTOMEGALOVIRUS ISOLATION (CYTOMEGALOVIRUS ISOLATION) CO2 Refer to CARBON DIOXIDE (BICARBONATE) (CARBON DIOXIDE) COBALAMINS (VITAMIN B12) 345 Serum Centrifuge only. TAT – 1 day TEST SPECIFICATION GUIDE - SECTION C Page 12 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. CML TEST NAME CODE COBALT 9917 SPECIMEN REQUIREMENT Plasma Separate Minimum Volume required: 3 mL. VACUTAINER ROYAL BLUE K2 EDTA BILL LOC $60.00 HLRC $60.00 HLRC OHIP CML N/C PHL OHIP CML TAT – 30 days COBALT 9918 Urine 50 mL random urine Submit in a 90 mL orange cap container. TAT – 30 days COCAINE SCREEN 078C Urine 10 mL random urine Submit in a blue cap conical tube. TAT – 2 days COCCIDIOIDES ANTIBODY 9012 Do not centrifuge tube PLAIN RED (VALLEY FEVER) ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days CODEINE Refer to DRUG SCREEN BROAD SPECTRUM COLD AGGLUTININS SCREEN 660 Serum and Clot PLAIN RED (AGGLUTINATION REACTION SCREEN) Blood drawn in a SST is not acceptable Clot at room temperature (preferable 37o C) Centrifuge immediately upon complete clot formation. Remove serum and transfer into a separation tube and send both serum and clot tube elastized together. DO NOT REFRIGERATE TAT – 1 day COLOGIC 9280 Serum GOLD SST $75.00 GOLD SST OHIP PLSI (GTA-446) Centrifuge and aliquot into serum tube Refrigerate during storage and transport TAT – 10 days COMPLEMENT C1 (ESTERASE INHIBITOR) 561 Serum Centrifuge only Refrigerate during storage and transport. TAT – 15 days TEST SPECIFICATION GUIDE - SECTION C Page 13 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. DYN TEST NAME CODE COMPLEMENT C1 ESTERASE INHIBITOR, FUNCTIONAL 9707 SPECIMEN REQUIREMENT VACUTAINER BILL LOC LIGHT BLUE $80.00 HLRC GOLD SST OHIP HLRC GOLD SST OHIP CML GOLD SST OHIP CML GOLD SST OHIP HLRC Plasma Minimum volume required: 2 mL FREEZE PLASMA AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 30 days COMPLEMENT C1Q Refer to C1Q IMMUNE COMPLEXES (C1Q IMMUNE COMPLEXES) (C1Q COMPLEMENT BINDING ACTIVITY) (IMMUNE COMPLEXES, C1Q) COMPLEMENT C2 9919 (C2) Serum Minimum Volume required: 2 mL Collect in pre-chilled tube Separate within one hour of collection and freeze serum as soon as possibleSubmission of duplicate aliquots is recommended in case of repeat analysis. Avoid multiple freeze/thaw. If thawed, specimen is unsuitable. FREEZE SERUM AND SEND FROZEN TAT – 30 days COMPLEMENT C3 551 (C3) Serum Centrifuge only TAT – 1 day COMPLEMENT C4 552 (C4) Serum Centrifuge only TAT – 1 day COMPLEMENT C5 (C5) 9708 Serum Minimum Volume required: 2 mL Only performed if CH50 is low FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 30 days TEST SPECIFICATION GUIDE - SECTION C Page 14 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE COMPLEMENT C6 9709 (C6) SPECIMEN REQUIREMENT VACUTAINER BILL LOC GOLD SST OHIP HLRC GOLD SST OHIP HLRC LAVENDER OHIP CML ROYAL BLUE - No Additive OHIP DYN OHIP DYN Serum 2 aliquots of 1 mL – keep aliquots together with elastic Only performed if CH50 is low FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 30 days COMPLEMENT,TOTAL CH50 530 (CH50) Serum Minimum Volume required: 2 mL (HEMOLYTIC COMPLEMENT FIXATION) FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 15 days COMPLETE BLOOD COUNT 393 Blood TAT – 1 day COOMBS TEST Refer to DIRECT ANTI-GLOBULIN TEST (DIRECT ANTI– GLOBULIN) (DIRECT COOMBS) (DIRECT ANTI–HUMAN GLOBULIN) COPPER 063 Serum Minimum Volume required: 3 mL Centrifuge and aliquot into serum tube Refrigerate during storage and transport. TAT – 20 days COPPER 063U 24-Hour Urine 50 mL aliquot –submit in a white cap container Refrigerate during storage and transport State total 24-hour volume on the OHIP Requisition, on the specimen container and in “Notes & Instructions”. Retain a duplicate 50 mL sample in the fridge until test is reported. TAT – 20 days COPPER 9520 Tissue Please entere specimen source required, e.g. Liver CONTAINER - STERILE FORM AVAILABLE ON CML WEBSITE TAT – 13 days TEST SPECIFICATION GUIDE - SECTION C Page 15 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. N/C LHSC TEST NAME CODE COPROPORPHYRINS SPECIMEN REQUIREMENT VACUTAINER BILL LAVENDER OHIP LOC Refer to PORPHYRINS, QUANTITATIVE (PORPHYRINS) (UROPORPHYRINS) CORTICOTROPIN 307 (ADRENOCORTICOTROPIC HORMONE) (ACTH) Plasma Minimum Volume required: 2 mL Collect specimen in the morning Fasting specimen preferred Collect in a chilled lavender vacutainer tube Mix well Place on ice while waiting for centrifugation Centrifuge within 30 minutes of collection DYN FREEZE PLASMA AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 15 days CORTISOL Plasma GREEN Indicate time of collection (AM, PM, Random) – with Heparin � A.M. � P.M. � RANDOM 303AP 303PP 303RP CORTISOL 303AM 303PM 303R � FREE 303UF CORTISOL CML OHIP CML OHIP CML Note: AM Collection Range: 6am – 10am Note: PM Collection Range: 3pm – 11pm Note: For specimens collected outside of AM and PM ranges TAT – 3 days Serum GOLD SST Centrifuge only Indicate time of collection (AM, PM, Random) � A.M. � P.M. � RANDOM OHIP Note: AM Collection Range: 6am – 10am Note: PM Collection Range: 3pm – 11pm Note: For specimens collected outside of AM and PM ranges TAT – 3 days 24-Hour Urine 10 mL aliquot – submit in a white cap conical tube labelled CREATININE and a 50 mL aliquot – submit in a 90 mL white cap container labelled CORTISOL FREE Testing includes urine creatinine and total volume. State total 24-hour volume on the OHIP Requisition, on the specimen container and in “Notes & Instructions” . Retain a duplicate 50 mL sample in the fridge until test is reported. TAT – 12 days CORTISOL � FREE RANDOM URINE 303RU Random urine Two 10ml random urines submitted in two white cap conical tubes. Testing includes Creatinine Random Urine Min urine required: 10ml TAT 12 days TEST SPECIFICATION GUIDE - SECTION C Page 16 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. OHIP CML TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC N/C PHL CORTISOL � TOTAL 303UT COUMADIN TEST NO LONGER AVAILABLE Refer to WARFARIN (WARFARIN) COXSACKIE VIRUS, ISOLATION 9008 (HAND, FOOT, MOUTH DISEASE) (ENTEROVIRUS) Stool / Rectal Swab / Throat Swab Viral history sheet must be completed. Stool is the preferred specimen ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM ▀ MINISTRY OF HEALTH GUIDELINES Refer to the General Information Page for the MOH Procedure regarding specimen processing & transport. Use appropriate MOH container: Stool– Virus–TM Rectal or Throat Swab– Virus–SW TAT – 15 to 30 days CREATINE CREATINE KINASE TEST NO LONGER AVAILABLE 066 (CK) (CPK) Serum Centrifuge only GOLD SST OHIP CML GOLD SST OHIP CML OHIP CML TAT – 1 day CREATINE KINASE-MB TEST NO LONGER AVAILABLE (CK-2 MB) CREATINE KINASE, FRACTIONATION TEST NO LONGER AVAILABLE (CK ELECTROPHORESIS) (CK ISOENZYMES) (CK FRACTIONATION) CREATININE 067 (eGFR) (ESTIMATED GFR) Serum Centrifuge only TAT – 1 day CREATININE 067U 24-Hour Urine 10 mL aliquot – submit in a white cap conical tube labelled CREATININE No Preservative State total 24-hour volume on the OHIP Requisition, on the specimen container and in “Notes & Instructions”. Retain a duplicate 90 mL sample in the fridge until test is reported. TAT – 1 day TEST SPECIFICATION GUIDE - SECTION C Page 17 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CREATININE CLEARANCE CODE 068 SPECIMEN REQUIREMENT VACUTAINER BILL LOC Serum and 24-Hour Urine GOLD SST OHIP centrifuge only and 10 mL urine aliquot – submit in a white cap conical tube No preservative Collect blood specimen at the end of the 24-hour urine collection. CML State total 24-hour volume, height and weight on the OHIP Requisition, on the specimen container and in “Notes & Instructions” . Retain a duplicate 50 mL sample in the fridge until test is reported.  Testing Includes serum creatinine, urine creatinine, total volume  TAT – 2 days CRP Refer to C-REACTIVE PROTEIN HIGH SENSITIVITY (C–REACTIVE PROTEIN) CRP-HIGH SENSIVITY Refer to C-REACTIVE PROTEIN HIGH SENSITIVITY (C–REACTIVE PROTEIN HIGH SENSITIVITY) CRYOFIBRINOGEN 599 Blood Do not open LIGHT BLUE OHIP CML GOLD SST OHIP CML PLAIN RED N/C PHL KEEP AT ROOM TEMPERATURE TAT – 1 day CRYOGLOBULINS, QUALITATIVE 600 Serum Centrifuge only Fasting specimen preferred. KEEP AT ROOM TEMPERATURE TAT – 1 day CRYPTOCOCCOSIS ANTIGEN 9009 Do not centrifuge tube ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM ▀ MINISTRY OF HEALTH GUIDELINES Refer to the General Information Page for the MOH Procedure regarding specimen processing & transport. TAT – 15 days CULTURE FUNGAL Refer to FUNGAL CULTURE TEST SPECIFICATION GUIDE - SECTION C Page 18 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE CULTURE & SENSITIVITY � BLOOD 624 SPECIMEN REQUIREMENT Blood Disinfect the venipuncture site first with 70% isopropyl alcohol, then with 10% Povidone Iodine Prep Pad VACUTAINER BLOOD CULTURE BOTTLES BILL LOC OHIP CML Cleanse the top of the tubes with 70% isopropyl alcohol Adult – take anaerobic and aerobic culture bottles Child – take aerobic culture bottle Collect the blood culture tubes first, then draw any other specimens required Collect at intervals specified by the physician. If none is given, a series of three Collections over a period of 24 hours to 48 hours is recommended. (12-24 hours between collections depending on patient’s accessibility To a collection centre) STATE THE DATE AND TIME OF COLLECTION ON THE BOTTLES State on the OHIP requisition: the patient’s home telephone number and the full information about the ordering physician . Bottles should not be refrigerated Specimen storage and transportation at room temperature. CULTURE & SENSITIVITY 628–4 � EAR � EYE / CONJUNCTIVA � NOSE / NARES Swab – state source Place swab in clear transport media OHIP CML OHIP CML OHIP CML Use code 628-44 for a second swab on same patient Specimen storage and transportation at room temperature. TAT – 2 to 3 days � CORD BLOOD TEST NO LONGER AVAILABLE CULTURE & SENSITIVITY 628–4 � EAR � EYE / CONJUNCTIVA � NOSE / NARES CULTURE & SENSITIVITY FEMALE G.C. ONLY � CERVICAL � ENDOCERVICAL � GONORRHOEAE 627 Swab – state source Place swab in clear transport media Use code 628-44 for a second swab on same patient Specimen storage and transportation at room temperature. TAT – 2 to 3 days Swab – state source Place swab in charcoal transport media Test is for N. gonorrhoeae only Specimen storage and transportation at room temperature. TAT – 3 days TEST SPECIFICATION GUIDE - SECTION C Page 19 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE CULTURE & SENSITIVITY 625 GENITAL � CERVICAL/VAGINAL � LABIA � PENIS/PENILE � VAGINAL � VAGINAL/ANAL � VAGINAL/RECTAL � VULVA SPECIMEN REQUIREMENT VACUTAINER Swab – state source Place swab in charcoal transport media BILL LOC OHIP CML Test is for N. gonorrhoeae, Yeast, Trichomonas and Bacterial Vaginosis Use code 625-2 for a second swab on same patient Specimen storage and transportation at room temperature. TAT – 3 days CULTURE & SENSITIVITY 625S GROUP B STREP SCREEN ONLY � VAGINAL � VAGINAL/RECTAL Swab Place swab in clear or charcoal transport media OHIP CML OHIP CML OHIP CML Specimen storage and transportation at room temperature. TAT – 5 to 7 days CULTURE & SENSITIVITY � ANY FLUID, EXCEPT SEMEN 639F Body Fluid – state source 10 mL Place fluid in a sterile container TAT – 3 days CULTURE & SENSITIVITY 628–5 � MISCELLANEOUS  Includes wound, skin, all abscesses, axilla, groin, discharge, eye lid, mouth, perianal, pharynx rectal abscess, tonsil Swab – state source Place swab in clear or charcoal transport media Use code 628-6 for a second routine swab on same patient Specimen storage and transportation at room temperature. TAT – 2 to 3 days CULTURE & SENSITIVITY � RECTAL / ANAL 628–9 Swab – Rectal Place swab in charcoal transport media. Specimen storage and transportation at room temperature. TAT – 3 days OHIP CML CULTURE & SENSITIVITY � SEMEN 639S Semen Minimum Volume required: 2 mL Place in sterile container TAT – 3 days OHIP CML CULTURE & SENSITIVITY � SPUTUM 629 Sputum Deep cough specimen in sterile container Use only 1 sample per requisition OHIP CML Specimen storage and transportation at 2-8 °C. TAT – 2 to 3 days TEST SPECIFICATION GUIDE - SECTION C Page 20 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CULTURE & SENSITIVITY � STOOL CODE 630–1 SPECIMEN REQUIREMENT VACUTAINER Stool Place stool in Cary–Blair transport container to the “FILL LINE” Shake to emulsify sample BILL LOC OHIP CML Only one request per requisition will be accepted unless authorized by Dr. P. Stuart – then code additional samples 630-2, 630-3. Specimen storage and ship refrigerated. Patient may present with a room temperature sample. This is acceptable. TAT – 3- to 4 days CULTURE & SENSITIVITY � THROAT 628 Swab – Throat Place swab in clear transport media OHIP CML OHIP CML OHIP CML State if patient is allergic to penicillin in “Notes and Instructions”. Test is for Beta Streptococcus Group A Use code 628-2 for a second swab on same patient Specimen storage and transportation at room temperature. TAT – 2 to 3 days CULTURE & SENSITIVITY � THROAT FOR STREP Refer to Culture & Sensitivity, Throat CULTURE & SENSITIVITY � URETHRAL Swab – Urethral – Male or Female Submit swab in charcoal transport media. 628–7 Specimen storage and transportation at room temperature. TAT – 3 days CULTURE & SENSITIVITY � URINE 634 Urine Collect a minimum of 10 mL of mid–stream urine in a sterile orange cap container Specimen storage and transportation at 2-8 °C. TAT – 1 to 3 days TEST SPECIFICATION GUIDE - SECTION C Page 21 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE CULTURE & SENSITIVITY SPECIMEN REQUIREMENT VACUTAINER QUICK REFERENCE CODING LIST For specimen requirements refer to the Individual test specifications SWAB SOURCE ALL ABSESSES CODE BILL LOC OHIP CML SWAB SOURCE 628-5 NASAL, MRSA Screen Test CODE 610-1 ANAL 628-9 NARES 628-4 AXILLA 628-5 NOSE 628-4 AXILLA, MRSA Screen Test 610-1 PENIS / PENILE 625 BLOOD 624 PERIANAL 628-5 CERVICAL 627 PHARYNX 628-5 CERVIX FOR G.C. 627 RECTAL 628-9 CERVIX/VAGINAL 625 RECTAL ABSCESS 628-5 CONJUNCTIVA 628-4 RECTAL, MRSA Screen Test 610-1 EAR 628-4 SEMEN 639S EAR LOBE 628-5 SKIN (includes FORESKIN) 628-5 ENDOCERVICAL 627 SLIDE FOR GRAM STAIN 643 EYE 628-4 SMEAR FOR GRAM STAIN 643 EYE LID 628-5 SPUTUM 629 FLUID, (All fluids except Semen) 639F STOOL 630-1 FORESKIN 628-5 GC ( includes URETHRA, THROAT, EYE, CERVIX when ONLY GC is ordered) 627 GONORRHOEAE (provide source) 627 THROAT - Allergic to penicillin 628 THROAT FOR STREP - Allergic to penicillin 628 TONSIL 628-5 ULCER (from any site) 628-5 GROIN 628-5 URETHRAL- MALE or FEMALE 628-7 GROIN, MRSA SCREEN TEST 610-1 URINE 634 GROUP B STREP SCREEN, VAG 625S VAGINAL 625 IUD 628-5 VAGINAL, GROUP B STREP SCREEN 625S LABIA 628-5 VAGINAL/ ANAL 625 LESION (from any site) 628-5 VAGINAL/ CERVICAL 625 MISCELLANEOUS (provide source) 628-5 VAGINAL/ RECTAL, Group B Strep Screen 625S MRSA Screen Test, AXILLA 610-1 VULVA 628-5 MRSA Screen Test, GROIN 610-1 WOUND 628-5 MRSA Screen Test, NASAL 610-1 VRE (source - RECTAL) 628-9 MRSA Screen Test, RECTAL 610-1 VRE (source – STOOL) MOUTH- Includes yeast/ thrush 628-5 Contact Micro MUTIPLE SWABS - on same patient Source First Swab Subsequent Swab(s) Eye, Ear, Nose 628-4 628-44 Throat 628 628-2 Miscellaneous 628-5 628-6 Vaginal, Vag/Cx, Vag/Anal 625 625-2 MRSA 610-1 610-2, 610-3, 610-4, 610-5 TEST SPECIFICATION GUIDE - SECTION C Page 22 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CYANIDE CODE 9920 SPECIMEN REQUIREMENT Whole blood Minimum volume required: 7 mL VACUTAINER BILL LOC $60.00 HLRC GOLD $50.00 HLRC LAVENDER OHIP HLRC ROYAL BLUE -with K2 EDTA DO NOT CENTRIFUGE – SEND ENTIRE TUBE TAT – 29 days CYCLIC CITRULLINATED PEPTIDE ANTIBODIES (anti-CCP) (CCP antibody) 9165 Serum Minimum volume required: 1 mL Centrifuge only Store and transport refrigerated Collect sample Monday – Wednesday only TAT – 15 days CYCLOSPORINE, TRANSPLANT 9153 Blood Place specimen, Hospital Form or copy of the OHIP requisition in a ziplock bag with a priority label. On priority label print `CYCLOSPORINE – TRANSPLANT’ Indicate name of transplant hospital and transplant physician on requisition. Keep cold during transport. TAT – variable CYCLOSPORINE, NON TRANSPLANT 9385 Blood LAVENDER State on the tube and requisition “non–transplant” OHIP HLRC OHIP HLRC Ensure that ALL of the patient information is Complete and clearly indicated – especially date of birth Keep cold during transport. TAT – variable CYSTINE (QUANTITATIVE) (CYSTINURIA MONITORING) 069U Random Urine 10 mL aliquot – submit in a 90 mL orange cap container. No preservative. FREEZE URINE AND SEND FROZEN. TAT – 18 days CYSTINE SCREEN Refer to METABOLIC SCREEN (CYSTINE QUALITATIVE) TEST SPECIFICATION GUIDE - SECTION C Page 23 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER CYTOLOGY 705 � ASPIRATION BIOPSY Slide and / or Aspiration Fluid Optimal volume 1 mL or more Includes all aspirations and or slides from:  ANY TUMOR  LYMPH NODE  MASS  NECK  NODULE The physician must print the patient's name on slide with a pencil. Apply directly from source or by means of applicator to slide. Fix slide immediately with cytospray. BILL LOC OHIP CML NOTE: If the sample is from thyroid, please include an additional clearly labelled air-dried slide, is possible. For fluid place sample in a labelled container, with name and source Fix with an equal volume of 50% ethanol to sample. Or CYST from:  BREAST  LYMPH NODE  SALIVARY GLAND  THYROID  OVARIES Complete a Cytology Form for samples. Assign the same accession number if a slide or fluid is submitted from the same site. Assign a separate accession number if a slide or fluid is submitted from different sites. Place a barcode on the mailer for easier identification. (NOTE: Bar code labels are in addition to the patient identification written directly on the slide). The physician must provide the patient’s history and clinical diagnosis e.g.:  Single/ multi nodular, hot /cold lesion, anterior/ posterior/ midline neck, parotid/ submandibular/ thyroid  Known previous or present malignancies, history of radiation  Breast feeding NOTE: It is important to state if the lump disappears after aspiration Do not code the Documentation Fee for this test. For transporation, follow irretrievable procedure TAT– 5 days CYTOLOGY 706 � BRONCHIAL WASHING OR BRUSHING Washings Optimal volume 5 mL or more OHIP Place specimen in labelled container. Fix washing with an equal volume of 50% ethanol to sample. Complete a Cytology Form for sample. The physician must provide the patient’s history and clinical diagnosis. Assign the same accession number if a slide or fluid is submitted from the same site. Assign a separate accession number if a slide or fluid is submitted from different sites. Do not code the Documentation Fee for this test. TAT – 5 days CYTOLOGY � BUCCAL SMEAR NO LONGER AVAILABLE TEST SPECIFICATION GUIDE - SECTION C Page 24 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. CML TEST NAME CODE CYTOLOGY 710 � DIRECT SMEAR  LARYNX  NIPPLE DISCHARGE  OPEN LESION  ORAL  VULVAR SPECIMEN REQUIREMENT VACUTAINER Slide BILL LOC OHIP CML DO NOT CONFUSE WITH ASPIRATION BIOPSY Refer to aspiration biopsy for source specification to ensure correct coding/processing The physician must collect and prepare a moderately thick smear of cellular material that displays no evidence of air drying.  ANAL The physician must print the patient's name on slide with a pencil. Apply directly from source or by means of applicator to slide. Fix slide immediately with cytospray. The physician must provide the patient’s history and clinical diagnosis e.g.:  Obvious lesions  Known previous or present malignancies  Breast feeding Complete a Cytology Form for each sample. Assign a separate accession number for each body site. Place a barcode on the mailer for easier identification. NOTES: · · Barcode label is in addition to the patient information written on the slide. Samples collected and received in liquid-based media are still considered a direct smear Do not code the Documentation Fee for this test. TAT – 5 days CYTOLOGY 714 � DIRECT SMEAR FOR HERPES (VIRAL INCLUSION) Slide The physician must scrape the lesion at the base of the blister and prepare a moderately thick smear of cellular material that displays no evidence of air drying. The physician must print the patient's name on slide with a pencil. Apply directly from source or by means of applicator to slide. Fix slide immediately with cytospray. Complete a Cytology Form for sample. Clinical data requested on requisition must be provided. Place a barcode on the mailer for easier identification. NOTE: Barcode label is in addition to the patient information written on the slide. Do not code the Documentation Fee for this test. TAT – 5 days TEST SPECIFICATION GUIDE - SECTION C Page 25 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. OHIP CML TEST NAME CODE CYTOLOGY 708 � WASHINGS/BRUSHINGS  ESOPHAGEAL  GASTRIC OR  ENDOMETRIAL SPECIMEN REQUIREMENT VACUTAINER Washings Optimal volume 5 mL or more Place specimen in labelled container Fix washing with an equal volume of 50% ethanol to sample BILL LOC OHIP CML Complete a Cytology Form for sample. The physician must provide the patient’s history and clinical diagnosis e.g.:  Known previous or present malignancies  Menstrual history (if endometrial wash) Do not code the Documentation Fee for this test. EXCLUDING: BRONCHIAL TAT – 5 days CYTOLOGY 711-2 � MISCELLANEOUS FLUID OR CYST Includes:     peritoneal fluid pleural fluid synovial fluid cysts from sources other than those listed below Fluid Optimal volume 5 mL or more OHIP CML For fluid sample place in a labelled container, fix with an equal volume of 50% ethanol to sample OR two slides are recommended Apply directly from source or by means of applicator to slide Fix slide immediately with cytospray The physician must print the patient’s name on the slides with a pencil. Assign the same accession number if a slide or fluid is submitted from the same site. Assign a separate accession number if s slide or fluid is submitted from different sites. Excludes, (Code as 705):  breast cyst  lymph nodes cyst  thyroid cyst  salivary gland cyst  ovarian cyst Complete a Cytology Form for samples The physician must provide the patient’s history and clinical diagnosis e.g.:  Gout/ pseudo gout  Septic joint  Known previous or present malignancies, history of radiation NOTE- It is important to state if the lump disappears after aspiration Do not code the Documentation Fee for this test TAT – 5 days CYTOLOGY, PAP SMEAR CP70 TEST NO LONGER AVAILABLE (PAPANICOLAOU SMEAR CONVENTIONAL) TEST SPECIFICATION GUIDE - SECTION C Page 26 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CYTOLOGY, PAP SMEAR MONOLAYER/THINLAYER CODE ML70 SPECIMEN REQUIREMENT VACUTAINER BILL LOC 30 mL Monolayer Container (SUREPATH) OHIP State source of the specimen: cervical, vaginal, endocervical, combined CML (PAPANICOLAOU SMEAR LIQUID BASED) NOTE: Ensure the head of the collection instrument (broom) is in the vial. NOTE: A maximum of 2 collection instrument heads per vial. (e.g. spaptula and brush) NOTE: Ensure the lid of the vial is screwed on tightly to avoid leakage or loss of the material. The physician must print the patient's name on the container. Complete a Cytology Form for sample. The physician must provide the patient’s history and clinical diagnosis e.g.:        Pregnant, post partum, hysterectomy LMP date Date smear was taken Patient’s date of birth Previous abnormal history Visible lesions Abnormal bleeding Place a barcode label on the vial for identification making sure not to cover Patient’s written name . DO NOT place barcode on the lid. Do not code the Documentation Fee for this test. TAT – 20 days CYTOLOGY � SPUTUM 716 Sputum Optimal volume 1-5 mL OHIP Place specimen in labelled container Fix washing with an equal volume of 50% ethanol to sample (Do NOT over saturate with alcohol) Collect specimens on 3 consecutive mornings (early morning deep cough samples) Samples should arrive at CCC no later than 12 hours after collection. Complete a Cytology Form for each sample The physician must provide the patient’s history and clinical diagnosis e.g.:     Smoker/non smoker, shortness of breath, pulmonary infections Hemoptysis Known previous or present malignancies Chest X ray results (if known) Assign a separate accession number for each specimen. Do not code the Documentation Fee for this test. TAT – 5 days TEST SPECIFICATION GUIDE - SECTION C Page 27 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. CML TEST NAME CYTOLOGY � URINE CODE 711U SPECIMEN REQUIREMENT VACUTAINER Urine Optimal volume 25-100 mL State if voided or catheterized urine collection BILL LOC OHIP CML Instruct the patient to drink approximately 5 glasses or more of water during a 2 hour period prior to do the test. Patient may urinate during this 2-hour period and discard urine. At the end of the 2 hour period, when the next urge to urinate arises, add a portion of this void to an equal volume of 50% ethanol. Suggest specimens be collected on 3 consecutive days. Samples should arrive at CCC no later than 12 hours after collection. Complete a Cytology Form for each sample. The physician must provide the patient’s history and clinical diagnosis e.g.:  History of radiation treatment  Known previous or present malignancies Assign a separate accession number for each specimen Note: Specify if voided or cathererized collection Do not code the Documentation Fee for this test TAT – 5 days CYTOMEGALOVIRUS ANTIBODY 9020 Do not centrifuge tube PLAIN RED N/C PHL N/C PHL Public Health Laboratories recommend the Collection of both acute and convalescent specimens taken two weeks apart. (CMV) ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM ▀ MINISTRY OF HEALTH GUIDELINES Refer to the General Information Page for the MOH Procedure regarding specimen processing & transport TAT – 25 days CYTOMEGALOVIRUS ISOLATION 9065 Urine/BronchialWashing ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM ▀ MINISTRY OF HEALTH GUIDELINES Refer to the General Information Page for the MOH Procedure regarding specimen processing & transport Refrigerate during storage and transport TAT – 20 days TEST SPECIFICATION GUIDE - SECTION C Page 28 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CYTOMEGALOVIRUS QUANTITATIVE PCR CODE 9549 SPECIMEN REQUIREMENT Plasma VACUTAINER LAVENDER Collect Mon through Thurs only. For transplant patients only. Centrifuge, separate into transfer tube and freeze immediately. Store and send frozen. TAT – 4 days TEST SPECIFICATION GUIDE - SECTION C Page 29 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. BILL N/C LOC HLRC TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC CYTOLOGY WORKSHEETS WORSHEET NAME & NUMBER 703 SPUTUM D/E CODES 716 DESCRIPTION (S) Sputum for Cytology. (Make sure sputum not saturated in alcohol, equal amount only). 706 ASPIRATION BIOPSY 705 All aspirations and/or slides from any tumor, mass, nodule. Cysts from breast, thyroid, lymph node, salivary gland (parotid, sub-mandibular) or ovary. If slide(s) and fluid(s) received from same site, same accession number is given. 707 BRONCHIAL WASHINGS/BRUSHINGS 706 Bronchial washings or brushings for cytology. If more than one bottle is received from the same site, same accession number is given. 708 BUCCAL SMEAR FOR BARR BODIES 709 WASHINGS/BRUSHINGS (other than Bronchial) No longer available 708 Washings or brushings from Gastric, Esophagus or Endometrium. (Excludes Bronchial Wash/Brush which is worksheet 707 D/E 706). 710 DIRECT SMEARS 711 MISCELLANEOUS FLUIDS 710 711-2 Direct smears from open lesions. Oral, vulvar, larynx smears. Nipple discharges/secretions. Anal smears. NOTE: Code as direct smear, even if any of the above are collected in a liquid-based media bottle. Synovial, pleural and peritoneal fluids. Cysts from sources other than those mentioned under aspiration biopsy above. 712 VIRAL INCLUSION 714 URINE 714 Direct smears for viral inclusions or herpes. 711U Voided or catheterized urines for Cytology. TEST SPECIFICATION GUIDE - SECTION C Page 30 of 30 CML HealthCare Inc Test Specification Guide 18353 Version: 24.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE 7–DEHYDROCHOLESTEROL 9975 (7DHC) SPECIMEN REQUIREMENT VACUTAINER Serum GOLD SST Minimum Volume required: 1 mL Fasting specimen preferred. Protect vacutainer tube from light after collection By aliquoting into amber tube. BILL LOC $95.00 HLRC GOLD SST $40.00 HLRC GOLD SST $60.00 HLRC Serum GOLD SST OHIP OHIP HLRC FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 35 days 11–DEOXYCORTISOL 9141 Serum Minimum Volume required: 1 mL FREEZE SERUM AND SEND FROZEN TAT – 30 days D. DIMER Refer to FIBRIN D-DIMER (FIBRIN D-DIMER) DALMANE Refer to FLURAZEPAM (FLURAZEPAM) DARVON Refer to PROPOXYPHENE (PROPOXYPHENE) DEAMIDATED GLIADIN PEPTIDE IGG ANTIBODY 9742 (DGP IgG) (DEAMIDATED GLIADIN PEPTIDE IGG AB) Serum Minimum Volume required: 1mL Centrifuge only TAT – 10 days DEHYDROEPIANDROSTERONE – SULPHATE 347 CML Centrifuge only (DHEA – S) (DHEA SULPHATE) TAT – 2 days DELTA–AMINOLEVULINATE (ALA) 9702 24-Hour Urine 50 mL aliquot – submit in a 90 mL white cap container Protect from light by wrapping with aluminium foil. Label container with one barcode; wrap container with foil. Place another label with barcode on top of foil overwrap. State total 24-hour volume on the OHIP Requisition, on the specimen container and in “Notes & Instructions” . Retain a duplicate 50 mL sample in the fridge until test is reported. TAT – 15 days DENGUE ANTIBODY Refer to ARBOVIRUS SEROLOGY (ARBOVIRUS SEROLOGY) TEST SPECIFICATION GUIDE – SECTION D Page 1 of 6 CML HealthCare Inc Test Specification Guide 18354 Version: 5.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE DEOXYPYRIDINOLINE SPECIMEN REQUIREMENT VACUTAINER BILL LOC N/C PHL OHIP DYN OHIP HLRC TESTING NO LONGER AVAILABLE (PYRIDINIUM) DEPAKENE Refer to VALPROATE (EPIVAL) (VALPROATE) DERMATOPHYTOSIS 9075 (RINGWORM OF SCALP) Hair Roots Submit only root ends of at least 12 hairs ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 25 days DESIPRAMINE 079D (NORPRAMINE) Serum ROYAL BLUE Minimum Volume required: 2 mL - No Additive Centrifuge and aliquot into serum tube Collect specimen 10 – 12 hours after last dose Record time in hours that have elapsed between last dose and specimen collection. Refrigerate during storage and transport. TAT – 20 days DESYREL Refer to TRAZODONE (TRAZ0DONE) DGP IGG Refer to DEAMIDATED GLIADIN PEPTIDE IgG Ab (DEAMIDATED GLIADIN PEPTIDE IGG AB) DHEA–S Refer to DEHYDROEPIANDROSTERONE SULPHATE (DHEA SULPHATE) (DEHYDROEPIANDROSTERONE – SULPHATE) DIASTASE Refer to AMYLASE (AMYLASE) DIAZEPAM (VALIUM) 074 Serum RED Minimum Volume required: 3 mL Collect trough specimen 10 – 12 hours after last dose or immediately prior to next dose. Record time in hours that have elapsed between last dose and specimen collection. TAT – 15 days DIBUCAINE INHIBITION TEST Refer to CHOLINESTERASE, PHENOTYPE TEST SPECIFICATION GUIDE – SECTION D Page 2 of 6 CML HealthCare Inc Test Specification Guide 18354 Version: 5.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME DIGOXIN CODE 306 (DIGITALIS) (LANOXIN) SPECIMEN REQUIREMENT VACUTAINER BILL LOC PLAIN RED OHIP CML OHIP HLRC $60.00 HLRC OHIP HLRC Serum Minimum Volume required: 2 mL Collect specimen 5 - 6 hours after last dose Record time in hours that have elapsed between last dose and specimen collection. Hemolysed specimen not acceptable TAT – 1 day DIGOXIN–FREE 9712 Serum Minimum Volume required: 2 mL PLAIN RED Record time in hours that have elapsed between last dose and specimen collection.  Testing Includes Total Digoxin  TAT – 15 days DIHYDROTESTOSTERONE 9131 Serum Minimum Volume required: 3 mL RED FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 30 days Refer to CALCITRIOL 1,25–DIHYDROXY (VITAMIN D) (CALCITRIOL) DIPHTHERIA ANTITOXIN SEROLOGY TESTING NO LONGER AVAILABLE (CORYNE BACTERIUM DIPHTHERIA TOXIN ANTIBODY) DILANTIN Refer to PHENYTOIN (PHENYTOIN) DILANTIN, FREE Refer to PHENYTOIN, FREE (PHENYTOIN, FREE) DIPHENHYDRAMINE (BENADRYL) 9409 Serum Minimum Volume required: 3 mL PLAIN RED TAT – 15 days TEST SPECIFICATION GUIDE – SECTION D Page 3 of 6 CML HealthCare Inc Test Specification Guide 18354 Version: 5.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE DIRECT ANTI–GLOBULIN TEST 495 SPECIMEN REQUIREMENT Blood (COOMBS TEST) (DIRECT ANTI-HUMAN GLOBULIN) (DIRECT COOMBS) DO NOT SEPARATE DIRECT BILIRUBIN Refer to BILIRUBIN, DIRECT VACUTAINER BILL LOC LAVENDER OHIP CML GREEN - with Heparin OHIP HLRC GOLD SST OHIP CML TAT – 2 days (CONJUGATED BILIRUBIN) (BILIRUBIN, DIRECT) DIRECT COOMBS Refer to DIRECT ANTI-GLOBULIN TEST (COOMBS TEST) (DIRECT ANTIHUMAN GLOBULIN) (DIRECT ANTI-GLOBULIN) DISOPYRAMIDE 076 (NORPACE) Plasma Sodium or Lithium heparinized plasma is acceptable. Centrifuge and separate plasma Minimum Volume required: 2 mL TAT – 15 days DIVALPROEX Refer to VALPROATE (DEPAKENE) (EPIVAL) (VALPROATE) (VALPROIC ACID) DNA dsANTIBODIES (DOUBLE STRANDED DNA Ab) 322 Serum Centrifuge only TAT – 5 days DNA SEQUENCING FOR HEMOGLOBINOPATHY INVESTIGATION Refer to HEMOGLOBINOPATHY INVESTIGATION DOPAMINE Refer to CATECHOLAMINES FRACTIONATED (CATECHOLAMINES FRACTIONATED) DORIDEN Refer to GLUTETHIMIDE (GLUTETHIMIDE) DOWN'S SYNDROME SCREEN Refer to MATERNAL SCREEN (MSS) (FETAL MARKERS) (TRIPLE MARKER TEST) (MATERNAL SERUM SCREEN) (IPS) TEST SPECIFICATION GUIDE – SECTION D Page 4 of 6 CML HealthCare Inc Test Specification Guide 18354 Version: 5.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME DOXEPIN CODE 079X (SINEQUAN) SPECIMEN REQUIREMENT VACUTAINER Serum PLAIN RED Minimum Volume required: 2 mL Centrifuge and aliquot into serum tube Collect trough specimen 10– 12 hours after last dose Record time in hours that have elapsed between last dose and specimen collection. BILL LOC OHIP HLRC OHIP CML OHIP CML OHIP CML OHIP CML Refrigerate during storage and transport  Testing Includes Desmethyl Doxepin  TAT – 20 days DRUG SCREEN � BROAD SPECTRUM 079 Urine 10 mL random urine (DRUG SCREEN CHROMATOGRAPHIC METHOD) Submit in a blue cap conical tube Test Confirmation / Broad Spectrum – code the test and Indicate the drug of interest in “Notes & Instructions” and on the OHIP Requisition. Includes: Methadone, Cocaine, Morphine, Heroin, Oxycodone, Diphenhydramine, Ranitidine, Nortriptyline, Amphetamine, Ephedrine/Pseudoephedrin, Phenylpropanolamine, and Other Drugs as detected TAT – 10 days DRUG SCREEN � WITH CREATININE, pH 078CR Urine 10 mL random urine Submit in a blue cap conical tube NOTE: Testing includes Drug Screen, pH, Creatinine TAT – 10 days DRUG SCREEN � WITH CREATININE, pH SODIUM, CHLORIDE 078RU Urine 10 mL random urine Submit in a blue cap conical tube NOTE: Testing includes Drug Screen, Ph, Creatinine, Sodium, Chloride TAT – 10 days DRUG SCREEN � WITH ALCOHOL 078A Urine 10 mL random urine Submit in a blue cap conical tube NOTE: Testing includes Drug Screen, and Ethanol TAT – 10 days TEST SPECIFICATION GUIDE – SECTION D Page 5 of 6 CML HealthCare Inc Test Specification Guide 18354 Version: 5.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE DRUG SCREEN - HAIR 9540 SPECIMEN REQUIREMENT VACUTAINER Hair BILL LOC $300.00 SKH $300.00 SKH $300.00 SKH OHIP CML Approx 20 strands (10mg) of hair required. Cut as close to the scalp as possible. (2-4mm) Place in small envelope/sterile container. This test is not available for CCC use. This test is only for use at Kennedy Road for hospital patients. Completed Sick Kids requisition is required. TAT – 18 days DRUG SCREEN - MECONIUM 9539 Meconium/feces 15 ml Submit in sterile container This test is not available for CCC use. This test is only for use at Kennedy Road for hospital patients. Completed Sick Kids requisition is required. TAT – 18 days DRUG SCREEN - NEONATE 9541 Urine 1.0 ml random urine Submit in sterile container This test is not available for CCC use. This test is only for use at Kennedy Road for hospital patients. Completed Sick Kids requisition is required. TAT – 4 days DRUGS OF ABUSE SCREEN (NARCOTIC SCREEN) (STREET DRUGS) (URINE TOXICOLOGY) 078U Urine 10 mL random urine Submit in a blue cap conical tube ● Testing Includes: Amphetamines, Benzodiazepine, Cocaine metabolite Cannabinoids (THC), Methadone Metabolite, Opiates, Oxycodone● NOTE: Any additional drugs of interest, drug analysis, indicate in “Notes & Instructions” and on the OHIP Requisition. TAT – 10 days TEST SPECIFICATION GUIDE – SECTION D Page 6 of 6 CML HealthCare Inc Test Specification Guide 18354 Version: 5.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC Refer to ESTRONE E1 (ESTRONE) Refer to ESTRADIOL E2 (ESTROGEN) (ESTRADIOL) (ESTROGEN- NON PREGNANT) TEST NO LONGER AVAILABLE E 3, PREGNANT (ESTRIOL TOTAL) Refer to EPSTEIN-BARR VIRUS, SEROLOGY EBV (EPSTEIN–BARR VIRUS, SEROLOGY) Refer to ELECTROCARDIOGRAM ECG (ELECTROCARDIOGRAM) ECHINOCOCCOSUS ANTIBODY 9088 Do not centrifuge tube PLAIN RED N/C PHL N/C PHL (ECHINOCOCCUS GRANULOSUS ANTIBODY) ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM (HYDATID) TAT – 15 days ECHOVIRUS ISOLATION 9059 Stool/ Throat swab/ Rectal Swab Complete a PHL Form Stool is the preferred specimen Stool Throat Swab Rectal Swab –VIRUS–TM –VIRUS–SW –VIRUS–SW ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 to 30 days eGFR Refer to CREATININE (CREATININE) E. HISTOLYTICA SEROLOGY ANTIBODY Refer to AMOEBIC ANTIBODY (AMOEBIC DYSENTERY SEROLOGY AB) (ENTAMOEBA HISTOLYTICA AB) ELAVIL Refer to AMITRIPTYLINE (AMITRIPTYLINE) TEST SPECIFICATION GUIDE - SECTION E Page 1 of 5 CML HealthCare Inc Test Specification Guide 18394 Version: 4.0 2-Dec-13 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER G310 – Technical Component G313 – Professional Component G700 – Documentation Fee G888 – Technical and professional Component for ECGs sent to Head Office ELECTROCARDIOGRAM (ECG) BILL LOC OHIP CML OHIP SBH Refer to location protocol for billing codes. ELECTRON MICROSCOPY 9756 Tissue (EM) Send specimen in an EM Fixative Kit Kit available from CML Purchasing Department Complete a Histology Form; follow irretrievable procedure Send the sample and the form in a Histology (pink) envelope with priority label in corner. State the name of the test and Sunnybrook Hospital on the priority label. TAT – 30 days Specify test: protein, immuno, Isoenzyme (alk phos, CK, LD), lipoprotein, or hemoglobin. ELECTROPHORESIS See separate listings. Refer to EXTRACTABLE NUCLEAR ANTIBODIES SCREEN ENA ANTIBODY (ANTI-ENA) (EXTRACTABLE NUCLEAR ANTIBODIES SCREEN) ENDOMYSIUM ANTIBODIES 9147 (ANTI-ENDOMYSIAL ANTIBODY) Serum Centrifuge only GOLD SST $55.00 HLRC $30.00 HLRC TAT – 21 days ENTEROVIRUS PCR 9284 Cerebral Spinal Fluid STERILE CONTAINER Accept any container/tube received Store and ship frozen TAT – 4 day EOSINOPHIL COUNT 395 Blood LAVENDER TAT – 1 day EOSINOPHIL SMEAR, EYE TEST NO LONGER AVAILABLE TEST SPECIFICATION GUIDE - SECTION E Page 2 of 5 CML HealthCare Inc Test Specification Guide 18394 Version: 4.0 2-Dec-13 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. OHIP CML TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER EOSINOPHIL SMEAR, NASAL TEST NO LONGER AVAILABLE EOSINOPHIL SMEAR, SPUTUM TEST NO LONGER AVAILABLE EPIDERMAL ANTIBODIES Refer to PEMPHIGUS/PEMPHIGOID ANTIBODIES BILL LOC (ANTI-SKIN ANTIBODIES) (PEMPHIGUS/PEMPHIGOID ANTIBODIES) Refer to VALPROATE EPIVAL (DEPAKENE) (VALPROATE) EPSTEIN–BARR VIRUS SEROLOGY 9040 Do not centrifuge tube PLAIN RED N/C PHL N/C HLRC Public Health Laboratories recommends both acute and convalescent specimens taken 2 weeks apart. (EBV) ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days EPSTEIN–BARR VIRUS QUANTITATIVE PCR (EBV VIRAL LOAD) (QUANTITATIVE EBV PCR) 9573 Do not centrifuge tube LAVENDER Collect Mon through Thurs only. For transplant patients only. Centrifuge, separate into transfer tube and freeze immediately. Store and send frozen. TAT – 10 days EQUANIL Refer to MEPROBAMATE (MEPROBAMATE) (MILTOWN) EQUINE ENCEPHALITIS ANTIBODIES Refer to ARBOVIRUS SEROLOGY (ARBOVIRUS SEROLOGY) TEST SPECIFICATION GUIDE - SECTION E Page 3 of 5 CML HealthCare Inc Test Specification Guide 18394 Version: 4.0 2-Dec-13 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC LAVENDER OHIP CML GOLD SST $70.00 HLRC GOLD SST OHIP CML Refer to PARVO VIRUS ERYTHEMA INFECTIOSUM (FIFTH’S DISEASE) (PARVO VIRUS ) (PARVO VIRUS B19) Refer to COMPLETE BLOOD COUNT ERYTHROCYTE COUNT (COMPLETE BLOOD COUNT) ERYTHROCYTE SEDIMENTATION 451 RATE (SED RATE) (SEDIMENTATION RATE) Blood Test must be performed within 10 hours of collection. TAT – 1 day ERYTHROPOIETIN 9132 Serum Minimum Volume required: 2 x 1 mL Keep aliquots together with elastic band. Avoid hemolysis Separate ASAP FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 30 days ESTRADIOL 310 Serum Centrifuge only (E 2) (ESTROGEN) (ESTROGEN-NON PREGNANT) TAT – 1 day ESTRIOL TOTAL, PREGNANT (E 3) TEST NO LONGER AVAILABLE ESTRIOL 9265 (E 3) Serum Centrifuge and aliquot into transfer tube. Store and ship refrigerated. TAT – 11 days GOLD SST OHIP HLRC Refer to ESTRADIOL ESTROGEN, NON PREGNANT (E 2) (ESTRADIOL) (ESTROGEN) ESTRONE (E 1) 313 Serum Minimum volume required: 1 mL GOLD SST FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 20 days TEST SPECIFICATION GUIDE - SECTION E Page 4 of 5 CML HealthCare Inc Test Specification Guide 18394 Version: 4.0 2-Dec-13 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. OHIP DYN TEST NAME ETHANOL CODE 006 (ALCOHOL- ETHYL) SPECIMEN REQUIREMENT VACUTAINER Blood GRAY Keep vacutainer tube sealed with minimum air space Use an iodine swab to cleanse venipuncture site BILL LOC OHIP CML OHIP CML OHIP DYN TAT – 2 days ETHANOL 006U (ALCOHOL- ETHYL) Urine 10 mL random urine Submit in a blue cap conical tube Keep container closed with minimum air space. TAT – 2 days NO LONGER AVAILABLE ETHCHLORVYNOL (PLACIDYL) ETHOSUXIMIDE 092 (ZARONTIN) Serum PLAIN RED Minimum Volume required: 1 mL Collect trough specimen 10 – 12 hours after last dose Record time in hours that have elapsed between last dose and specimen collection. TAT – 3 days ETHYLENE GLYCOL 9133 (ANTIFREEZE) Whole blood Do not sperarate. Send entire tube. Will require consultation with biochemist On-call (905-521-2100 x76443) BEFORE Sending specimen to HLRC. GRAY $40.00 HLRC This test is not available for CCC use. This test is only for use at Kennedy Road for hospital patients TAT – 4 days EXTRACTABLE NUCLEAR ANTIBODIES SCREEN (ANTI-ENA) (ENA ANTIBODY) 9593 Serum GOLD SST Centrifuge only Positive results may be delayed for confirmation Note: Specific antigens reported only when screen is positive OHIP HLRC  Includes antibody screen for: dsDNA; Chromatin; Ribosomal Protein; SS-A52 SS-A60; SS-B; Sm; SmRNP; RNP A, RNP 68; Scl-70; Jo-1; Centromere B  TAT – 30 days TEST SPECIFICATION GUIDE - SECTION E Page 5 of 5 CML HealthCare Inc Test Specification Guide 18394 Version: 4.0 2-Dec-13 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC LIGHT BLUE OHIP HLRC OHIP HLRC NO LONGER AVAILABLE FACTOR ASSAY (COAGULATION FACTOR) FACTOR II ASSAY 9758 Plasma 1 mL sodium citrate platelet poor plasma. Centrifuge and aliquot to transfer tube immediately. Store and ship frozen. TAT 10 days FACTOR V ASSAY 9759 Plasma LIGHT BLUE 1 mL sodium citrate platelet poor plasma. Centrifuge and aliquot to transfer tube immediately. Store and ship frozen. TAT 10 days FACTOR V LEIDEN MUTATION 9149 Blood 1 LAVENDER 1 LIGHT BLUE $75.00 HLRC ▀ Lavender ▀ Light Blue → Unspun → separate 2 mL plasma, FREEZE → Label tube – Factor V Leiden → label tube – APC Resistance / Factor V Leiden (FVL) (INCLUDES APCR) Heparin is to be restricted one week prior to test collection Patient must contact their physician for restriction guidelines FREEZE PLASMA FROM LIGHT BLUE AND SEND FROZEN Keep lavender at room temperature, send together. Refer to the General Information page for the Specimen Processing & Transport Guidelines. NOTE: NOT THE SAME AS FACTOR V TAT – 40 days FACTOR VII ASSAY 9760 Plasma LIGHT BLUE OHIP HLRC OHIP HLRC Please used specifically defined test codes Each individual factor assay. Spin and separate platelet poor plasma immediately. Store and ship frozen. TAT – 10 days FACTOR VIII INHIBITOR (FACTOR VIII INHIBITO – HUMAN BETHESDA) 9761 Plasma LIGHT BLUE 1 mL sodium citrate platelet poor plasma. Centrifuge and aliquot to transfer tube immediately. Store and ship frozen. Von Willebrand Factor VIII-C result is included as part of the test. TAT 13 days TEST SPECIFICATION GUIDE – SECTION F Page 1 of 7 CML HealthCare Inc Test Specification Guide 18207 Version: 5.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC Refer to VON WILLIBRAND FACTOR SCREEN FACTOR VIII: C VON WILLEBRAND (BIOLOGICAL) FACTOR IX ASSAY 9762 Plasma LIGHT BLUE OHIP HLRC OHIP HLRC OHIP HLRC OHIP HLRC OHIP HLRC OHIP HLRC (FACTOR 9) 1 mL sodium citrate platelet poor plasma. Centrifuge and aliquot to transfer tube immediately. Store and ship frozen. TAT 10 days FACTOR X ASSAY 9763 Plasma LIGHT BLUE 1 mL sodium citrate platelet poor plasma. Centrifuge and aliquot to transfer tube immediately. Store and ship frozen. TAT 10 days FACTOR XI ASSAY 9764 Plasma LIGHT BLUE 1 mL sodium citrate platelet poor plasma. Centrifuge and aliquot to transfer tube immediately. Store and ship frozen. TAT 10 days FACTOR XII ASSAY 9765 Plasma LIGHT BLUE 1 mL sodium citrate platelet poor plasma. Centrifuge and aliquot to transfer tube immediately. Store and ship frozen. TAT 10 days FACTOR XIII Panel 9256 Plasma LIGHT BLUE Draw 2 light blue vacutainers to ensure enough plasma. Send platelet poor plasma in three 1ml aliquots. Separate and freeze immediately. Ship frozen. Put an elastic around all aliquots to keep them together. Patient should not be on anticoagulant therapy. TAT – 13 days. FACTOR XIII SCREEN (UREA CLOT SOLUBILITY) 9766 Plasma LIGHT BLUE 1 mL sodium citrate platelet poor plasma. Centrifuge and aliquot to transfer tube immediately. Store and ship frozen. TAT 10 days TEST SPECIFICATION GUIDE – SECTION F Page 2 of 7 CML HealthCare Inc Test Specification Guide 18207 Version: 5.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC Refer to ALLERGIC ALVEOLITIS FARMERS LUNG (ALLERGIC ALVEOLITIS) (ALLERGIC LUNG) NO LONGER AVAILABLE FAT AND MEAT FIBRES MICROSCOPIC EXAMINATION FAT GLOBULES 9229 (FAT SCREEN) (FECAL FAT SCREEN) 1g sample STERILE CONTAINER OHIP HLRC GOLD SST OHIP HLRC GOLD SST $60.00 HLRC 1 gram of stool to be submitted in an orange cap urine container. TAT – 7 days FATTY ACID, FREE 9418 (FATTY ACIDS, NONESTERIFIED) Serum Minimum Volume required: 1 mL Must fast a minimum of 12 hours FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 30 days FATTY ACID, VERY LONG CHAIN 9134 Serum Minimum Volume required: 2 mL Note: not the same as Fatty acid, free FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 30 days NO LONGER AVAILABLE FEBRILE AGGLUTININS FECAL FAT, TOTAL 095 Stool 72 HOUR CAN This test is available only for use At Kennedy Road for hospital patients And is not available for CCC use. Please note Whether 48 hour or 72 hour collection OHIP HLRC TAT – 14 days FERRITIN 329 Serum Centrifuge only 3 MICROTAINERS ARE REQUIRED WHEN COLLECTING FROM AN INFANT TAT – 1 day GOLD SST TEST SPECIFICATION GUIDE – SECTION F Page 3 of 7 CML HealthCare Inc Test Specification Guide 18207 Version: 5.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. OHIP CML TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC LIGHT BLUE OHIP CML LIGHT BLUE OHIP CML OHIP CML Refer to HEMOGLOBIN FRACTIONATION FETAL HEMOGLOBIN (HEMOGLOBIN A2) (HEMOGLOBIN FRACTIONATION) (HEMOGLOBIN FETAL) FIBRIN D-DIMER 405 (FIBRIN DEGRADATION PRODUCTS) (D. DIMER) Plasma Minimum Volume required: 1 mL Centrifuge within 30 minutes. FREEZE PLASMA AND SEND FROZEN TAT – 2 days FIBRINOGEN, QUANTITATIVE 402 Plasma Fill tube completely Do not centrifuge TAT – 1 day Refer to PARVO VIRUS FIFTH’S DISEASE (ERYTHEMA INFECTIOSUM) (PARVO VIRUS ) (PARVO VIRUS B19) Refer to TACROLIMUS FK – 506 (PROGRAF) (TACROLIMUS) State source – synovial, knee fluid, aspirate, etc. FLUID, TOTAL EXAM (SYNOVIAL FLUID) HP10 a) Uric Acid Crystals & Cells – transfer to a Lavender tube 639F b) Culture - transfer to a 90 mL white cap container - print FLUID on lid Serum Codes c) Chemistry - transfer to a plain red tube - code test(s) according to serum codes - tests are usually protein (208FL) and glucose (111RS) State tests requested in “Notes & Instructions” Submit all fluids in a priority labelled zip-lock bag. Results may be delayed due to confirmation by Pathologist  Testing Includes LKcs, crystals, chemistry, differential  TAT – 4 days FLUORESCENT ABSORPTION TEST Refer to SYPHILIS (FTA- TREPONEMAL ANTIBODIES) (TREPONEMAL ANTIBODIES) (SYPHILIS) TEST SPECIFICATION GUIDE – SECTION F Page 4 of 7 CML HealthCare Inc Test Specification Guide 18207 Version: 5.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME FLUORIDE CODE 9224 SPECIMEN REQUIREMENT Serum Minimum Volume required: 2 mL Transfer serum to plastic serum tube VACUTAINER BILL LOC PLAIN RED $40.00 HLRC GREEN – with Heparin OHIP HLRC 2 LAVENDER OHIP CML GOLD SST OHIP CML LAVENDER OHIP VTF TAT – 25 days URINE TESTING NO LONGER AVAILABLE FLUORIDE FLUOXETINE 9107 (PROZAC) Plasma Minimum Volume required: 2 mL Collect trough sample 10 –12 hours after last dose Record time in hours that have elapsed between last dose and specimen collection. TAT – 20 days TEST NO LONGER AVAILABLE FLURAZEPAM (DALMANE) TEST NO LONGER AVAILABLE FLUVOXAMINE (LUVOX) FOLATE, RBC 309 Blood Note: If routine hematology tests are NOT ordered, an additional lavender tube is required for hematocrit  Testing Includes Hematocrit  TAT– 2 days FOLLITROPIN 315 (FOLLICLE STIMULATING HORMONE) Serum Centrifuge only (FSH) TAT – 1 day FRAGILE X CHROMOSOME 9714 Whole Blood DO NOT SPIN Collect sample Monday – Wednesday only A form for Molecular Genetic DNA Testing must be completed by the doctor and accompany the specimen Form available from CML Problem Solving Department. Store and transport specimen at room temperature Place specimen and form in a test labelled priority labelled zip-lock bag State “FRAGILE X” on the priority label TAT – 30 days TEST SPECIFICATION GUIDE – SECTION F Page 5 of 7 CML HealthCare Inc Test Specification Guide 18207 Version: 5.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL GOLD SST $45.00 LOC Refer to HEMOGLOBIN PLASMA FREE HEMOGLOBIN (PLASMA HEMOGLOBIN) (HEMOGLOBIN PLASMA) FREE KAPPA/LAMBDA RATIO 9247 (SERUM FREE LIGHT CHAINS) Serum Centrifuge and aliquot to transfer tube. Store and ship refrigerated. HLRC TAT – 8 days Refer to TRIIODOTHYRONINE FREE FREE T3 (TRIIODOTHYRONINE FREE) Refer to THYROXINE FREE FREE T4 (FREE THYROXINE) (THYROXINE FREE) Refer to TESTOSTERONE FREE FREE TESTOSTERONE (TESTOSTERONE FREE) FREE THYROXINE INDEX (FTI) TEST NO LONGER AVAILABLE FREE / TOTAL PSA Refer to PROSTATE SPECIFIC ANTIGEN FREE/TOTAL (PSA FREE AND TOTAL RATIO) (PSA PERCENT %) (PSA FRACTIONATION) Refer to CLOBAZAM FRISIUM (CLOBAZAM) FRUCTOSAMINE 9114 Serum Centrifuge only GOLD SST $30.00 HLRC OHIP DYN TAT – 20 days FRUCTOSE 9211 Semen Minimum Volume required: 1 mL Freeze within 30 minutes after collection FREEZE SEMEN AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 20 days TEST SPECIFICATION GUIDE – SECTION F Page 6 of 7 CML HealthCare Inc Test Specification Guide 18207 Version: 5.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC OHIP CML Refer to FOLLITROPIN FSH (FOLLICLE STIMULATING HORMONE) (FOLLITROPIN) Refer to SYPHILIS FTA (FLUORESCENT ABSORPTION TEST) (FTA- TREPONEMAL ANTIBODIES) (SYPHILIS) TEST NO LONGER AVAILABLE FTI (FREE THYROXINE INDEX) FUNGAL CULTURE 626 Skin Scrapings, Nails, Hairs State Source Submit specimen in heavy black paper placed in a plastic transport container. STORE AND SHIP AT ROOM TEMPERATURE Use code 626-2 for second specimen on same patient, 626-3 for third specimen TAT – 10 to 30 days FUNGAL CULTURE 641-1 Sputum Early morning deep cough specimen Submit specimen in a 90 mL transport container STORE AND SHIP AT ROOM TEMPERATURE ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM – CODE M04 ON PHL REQUISITION TAT – 10 to 30 days FVL Refer to FACTOR V LEIDEN MUTATION (FACTOR V LEIDEN MUTATION) (INCLUDES APCR) TEST SPECIFICATION GUIDE – SECTION F Page 7 of 7 CML HealthCare Inc Test Specification Guide 18207 Version: 5.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. N/C PHL TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC Refer to GLUCOSE-6-PHOSPHATE DEHYDROGENASE G6PD (GLUCOSE–6–PHOSPHATE DEHYDROGENASE ASSAY) 9922 GABAPENTIN (NEURONTIN) Serum PLAIN RED Minimum Volume required: 2 mL Collect trough specimen 10 to 12 hours after last dose Record time in hours that have elapsed between last dose and specimen collection. OHIP HLRC FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 20 days TESTING NO LONGER AVAILABLE GALACTOSE–1–PHOSPHATE URIDYL TRANSFERASE (GALACTOSE-1 PUT) GALECTIN-3 9288 Serum GOLD SST Minimum Volume required: 1 mL Centrifuge and aliquot serum into transfer tube. Store and send refrigerated. $78.00 LL TAT – 14 Days Refer to IMMUNOGLOBULIN GAM GAM (IMMUNO GAM) (IMMUNOGLOBULIN, QUANTITATIVE) GAMMA–GLUTAMYL TRANSFERASE 107 Serum Centrifuge only GOLD SST OHIP CML Serum PLAIN RED Minimum Volume required: 2 x 1mL Submit two aliquots kept together with elastic band. OHIP HLRC (GGT) (GGTP) TAT – 1 day (GAMMA GLUTAMYL TRANSPEPTIDASE) GANGLIOSIDE ANTIBODY (GM1 GANGLIOSIDE ANTIBODY) 9715 FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 30 days TEST SPECIFICATION GUIDE – SECTION G Page 1 of 5 CML HealthCare Inc Test Specification Guide 18340 Version: 5.0 20-Feb-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME GASTRIN CODE 316 SPECIMEN REQUIREMENT VACUTAINER Serum PLAIN RED Minimum Volume required: 2 mL Patient must fast minimum of 10 hours prior to collection BILL LOC OHIP CML OHIP HLRC OHIP HLRC $90.00 HLRC FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 10 days TEST NO LONGER AVAILABLE GCFT (GONOCOCCAL COMPLEMENT FIXATION TEST) (GONOCCAL INFECTION) Refer to BLOOD GROUP PHENOTYPE GENOTYPE (ABO, Rh(D), GENOTYPE) (BLOOD GROUP, Rh(D) AND GENOTYPE) GENTAMICIN, PEAK 304GP (POST) Serum PLAIN RED Minimum Volume required: 1 mL Collect ½ hour after IV infusion, or 1-2 hours after IM injection. Record time in minutes that has elapsed between last dose and specimen collection. FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 5 to 10 days GENTAMICIN, TROUGH 304GT (PRE) Serum Minimum Volume required: 1 mL Collect prior to IV infusion or IM injection. Record time in minutes that has elapsed between last dose and specimen collection. PLAIN RED FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 5 to 10 days Refer to GAMMA GLUTAMYL TRANSFERASE GGT (GGPT) (GAMMA–GLUTAMYL TRANSPEPTIDASE) (GAMMA GLUTAMYL TRANSFERASE) GLIADIN ANTIBODIES (AGA) (ANTI–GLIADIN) 9117 Serum Centrifuge only GOLD SST  Testing Includes Gliadin antibody IgG, IgA  TAT – 25 days GLOBULIN TEST NO LONGER AVAILABLE TEST SPECIFICATION GUIDE – SECTION G Page 2 of 5 CML HealthCare Inc Test Specification Guide 18340 Version: 5.0 20-Feb-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE 9295 GLUCAGON SPECIMEN REQUIREMENT VACUTAINER Plasma LAVENDER Collect fasting specimen in pre-chilled tube. After draw, chill whole blood on ice for min. 10 minutes then spin down in refrigerated centrifuge. Separate and freeze as soon as possible. Store and send frozen. If thaws unsuitable for analysis. BILL LOC $70.00 HRLC TAT – 14 days GLOMERULAR BASEMENT MEMBRANE ANTIBODY 9435 Serum Centrifuge only GOLD SST OHIP HLRC GRAY OHIP CML GOLD SST OHIP CML GRAY OHIP CML OHIP CML TAT – 20 days GLUCOSE � � � FASTING RANDOM PC 111F 111R 111PC Plasma Minimum Volume required: 2 mL NOTE: PC is available for 2 hour specimens only TAT – 1 day GLUCOSE � � FASTING RANDOM 111FS 111RS Serum Centrifuge only TAT – 1 day Plasma Do not centrifuge GLUCOSE CHALLENGE 75 gm glucose load 3106 3108 FASTING PLASMA 2-HOUR PLASMA AFTER 75gm GLUCOSE LOAD Collect a fasting grey top tube Give patient 75 gm glucose drink Collect a gray top tube 2 hours after drink given Record glucose load given Note: No urine required Testing for non-pregnant females and males. TAT – 1 day GLUCOSE CHALLENGE, GESTATIONAL SCREEN - 50g glucose load 103S Plasma Do not centrifuge GRAY Give patient 50 g glucose drink Collect a gray top tube 1-hour after drink given Record glucose load given TAT – 1 day TEST SPECIFICATION GUIDE – SECTION G Page 3 of 5 CML HealthCare Inc Test Specification Guide 18340 Version: 5.0 20-Feb-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME GLUCOSE CHALLENGE, O’ SULLIVAN SCREEN - 50g glucose load CODE 111F 103S SPECIMEN REQUIREMENT VACUTAINER Plasma Do not centrifuge Collect a fasting gray top tube BILL LOC GRAY OHIP CML GRAY OHIP CML OHIP CML Give patient 50 g glucose drink Collect a gray top tube 1 hr after drink given Record glucose load given TAT – 1 day GLUCOSE CHALLENGE GESTATIONAL SCREEN - 75g glucose load 3008 Plasma Do not centrifuge Collect a fasting gray top tube DO NOT collect a fasting urine sample DO NOT COLLECT A 3 HR SPECIMEN Give patient 75 g glucose drink Collect a gray top tube 1 hr and 2 hrs after drink given Record glucose load given TAT – 1 day GLUCOSE CHALLENGE GESTATIONAL SCREEN - 100g glucose load 103 Plasma / Urine Do not centrifuge Collect a fasting urine sample Collect a fasting grey top tube GRAY Give patient 100 g glucose drink Collect a gray top tube 1hr, 2hr, and 3 hrs after drink given Record glucose load given NOTE: If fasting urine is not collected record in “Notes & Instructions” and on the OHIP requisition. TAT – 1 day GLUCOSE-6-PHOSPHATE DEHYDROGENASE ASSAY 9973 Blood Do not open tube LAVENDER OHIP HLRC OHIP CML (G6PD ASSAY) TAT – 15 days TEST NO LONGER AVAILABLE GLUCOSE–6–PHOSPHATE DEHYDROGENASE SCREEN (G6PD SCREEN) GLUCOSE, QUALITATIVE 254–4 Urine 10 mL random urine Submit in a YELLOW cap conical tube TAT – 1 day TEST SPECIFICATION GUIDE – SECTION G Page 4 of 5 CML HealthCare Inc Test Specification Guide 18340 Version: 5.0 20-Feb-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER GLUCOSE TOLERANCE, – 75g glucose load Refer to GLUCOSE CHALLENGE GLUTETHIMIDE SERUM TESTING NO LONGER AVAILABLE BILL LOC (DORIDEN) URINE TESTING NO LONGER AVAILABLE GLUTETHIMIDE (DORIDEN) GLYCOPROTEIN ALPHA SUBUNIT NO LONGER AVAILABLE Refer to HEMOGLOBIN A1C GLYCOSYLATED HEMOGLOBIN (A1C) (HbA1C) (HEMOGLOBIN A1C) GM 1 GANGLIOSIDE ANTIBODY Refer to GANGLIOSIDE ANTIBODY GOLD NO LONGER AVAILABLE GONORRHOEAE SWAB Refer to CULTURE AND SENSITIVITY GONORRHOEAE URINE 9166 (GC) Urine 20 - 40 mL N/C PHL OHIP CML Collect the first part of the urine stream to ensure a high organism count. Higher volumes of urine will invalidate the test. ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM - CODE B11 TAT–15 days GRAM STAIN 643 Smear – state source Label frosted end of prepared slide TAT – 1 day GROWTH HORMONE Refer to SOMATOTROPIN (HGH) (HUMAN GROWTH HORMONE) (SOMATOTROPIN) GTA-446 Refer to COLOGIC TEST SPECIFICATION GUIDE – SECTION G Page 5 of 5 CML HealthCare Inc Test Specification Guide 18340 Version: 5.0 20-Feb-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC TEST NO LONGER AVAILABLE HALCION (TRIAZOLAM) HALOPERIDOL 9118 (HALDOL) Plasma GREEN Minimum Volume required: 3 mL – with Heparin Separate immediately Collect trough specimen prior to next dose Record time in hours that have elapsed between last dose and specimen collection. OHIP HLRC OHIP CML FREEZE PLASMA AND SEND FROZEN TAT – 15 to 25 days Refer to COXSACKIE VIRUS ISOLATION HAND, FOOT, MOUTH DISEASE (COXSACKIE VIRUS ISOLATION) HAPTOGLOBIN 120 Serum Centrifuge only Avoid hemolysis GOLD SST TAT – 1 day HbA1C Refer to HEMOGLOBIN A1C HCG Refer to CHORIOGONADOTROPIN (A1C) (GLYCOSYLATED HEMOGLOBIN) (HEMOGLOBIN A1C) (BHCG) (HUMAN CHORIONIC GONADOTROPIN) HDL CHOLESTEROL Refer to LIPID ASSESSMENT, FASTING/LIPID ASSESSMENT, NON FASTING (CHOLESTEROL IN HDL) HDL/LDL CHOLESTEROL Refer to LIPID ASSESSMENT, FASTING/LIPID ASSESSMENT, NON FASTING (LDL CHOLESTEROL) (CHOLESTEROL IN LDL) HEAVY & LIGHT CHAINS Refer to IMMUNOELECTROPHORESIS (IMMUNOELECTROPHORESIS) (IMMUNOFIXATION) (GAMMOPATHY TYPING) TEST SPECIFICATION GUIDE – SECTION H Page 1 of 15 CML HealthCare Inc Test Specification Guide 18228 Version: 14.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC Refer to PROTEIN ANALYSIS – BENCE JONES PROTEIN HEAVY & LIGHT CHAINS (BENCE JONES PROTEIN) (IEP) (IMMUNOELECTROPHORESIS) HEINZ BODIES 9718 Blood LAVENDER Do not open tube Part of hemolytic investigation – form available from Problem Solving Department at Head Office. OHIP HLRC OHIP CML TAT –30 days HELICOBACTER PYLORI 683 (H. PYLORI) (H. PYLORI ANTIBODY) Serum Centrifuge only GOLD SST TAT – 3 days Refer to COMPLETE BLOOD COUNT HEMATOCRIT HEMOCHROMATOSIS 9977 (HFE C282Y, H63D) Blood 2 LAVENDERS OHIP Specimen must be analysed within 24-hours Submit Monday – Wednesday only A doctor must complete a Molecular Diagnostic DNA Testing form Form available from CML Problem Solving Department. HLRC Transport specimens and Form in a Priority labelled ziplock bag. DO NOT REFRIGERATE TAT – 25 DAYS Refer to COMPLETE BLOOD COUNT HEMOGLOBIN HEMOGLOBIN A1C 093 (A1C) (HbA1C) (GLYCOSYLATED HEMOGLOBIN) HEMOGLOBIN A2 Blood LAVENDER OHIP CML LAVENDER OHIP HLRC LAVENDER OHIP CML TAT – 2 days 9959 QUANTITATION COLUMN Blood Do not open the tube TAT – 15 days HEMOGLOBIN FRACTIONATION (FETAL HEMOGLOBIN) (HEMOGLOBINOPATHY SCREENING) (HEMOGLOBIN ELECTROPHORESIS) 419 Blood Do not open the tube Abnormal results may be delayed due to interpretation by consultant. TAT – 1 day TEST SPECIFICATION GUIDE – SECTION H Page 2 of 15 CML HealthCare Inc Test Specification Guide 18228 Version: 14.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE HEMOGLOBIN PLASMA SPECIMEN REQUIREMENT VACUTAINER BILL LAVENDER $60.00 LOC Refer to METHEMALBUMIN SCREEN (FREE HEMOGLOBIN) (PLASMA HEMOGLOBIN) HEMOGLOBINOPATHY INVESTIGATION – STAGE 1 9251 Whole Blood HLRC Please provide current CBC results. A hemoglobinopathy investigation form should be completed along with specimen and requisition. If investigating Alpha Thalassemia or a rare HB variant send extra lavender tube. (DNA SEQUENCING FOR HEMOGLOBINOPATHY INVESTIGATION) FORM AVAILABLE ON CML WEBSITE TAT – 13 days Refer to COMPLEMENT TOTAL CH50 HEMOLYTIC COMPLEMENT FIXATION (CH50) (COMPLEMENT HEMOLYTIC) HEMOLYTIC INVESTIGATIONS 9253 STAGE 1 Whole Blood Please provide current CBC results Hemolytic investigation form should be Completed and sent with req. LAVENDER $60.00 HLRC PLAIN RED $60.00 HLRC OHIP HLRC $50.00 HRLC FORM AVAILABLE ON CML WEBSITE TAT – 8 days HEMOPEXIN 9925 Serum Minimum Volume required: 2 mL Collect Monday – Wednesday only. TAT – 20 days HEMOSIDERIN 424 Urine 10 mL random urine Submit in a 90 mL orange cap container First morning sample TAT –20 days HEPARIN ASSAY (XA INHIBITOR) – FONDAPARINUX (ARIXTRA) 9543 Plasma LIGHT BLUE Separate and freeze Minimum Volume required: 1 mL FREEZE PLASMA AND SEND FROZEN Refer to the General Information Page for State type of drug patient is on. TAT– 4 days TEST SPECIFICATION GUIDE – SECTION H Page 3 of 15 CML HealthCare Inc Test Specification Guide 18228 Version: 14.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME HEPARIN ASSAY (XA INHIBITOR) – UNFRACTIONATED CODE 9537 SPECIMEN REQUIREMENT VACUTAINER Plasma BILL LOC LIGHT BLUE $29.00 HRLC LIGHT BLUE OHIP HRLC LIGHT BLUE $35.00 HRLC PLAIN RED OHIP Separate and freeze Minimum Volume required: 1 mL FREEZE PLASMA AND SEND FROZEN Refer to the General Information Page for State type of drug patient is on. TAT– 4 days HEPARIN ASSAYORGARAN 9243 Plasma Separate and freeze Minimum Volume required: 1 mL FREEZE PLASMA AND SEND FROZEN TAT– 4 days HEPARIN CO FACTOR II 9178 Plasma Separate and freeze Minimum Volume required: 1 mL FREEZE PLASMA AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT– 20 days HEPARIN INDUCED THROMBOCYTOPENIA 9353 (HIT) Serum Minimum Volume required: 4 mL Centrifuge, separate into transfer tube. Freeze immediately. Store and send frozen. Send Platelet Immunology Lab requisition. MUMC FORM AVAILABLE ON CML WEBSITE TAT– TBD HEPARIN LOW MOLECULAR WEIGHT 9252 Plasma LIGHT BLUE Minimum Volume required: 2 mL Separate platelet poor plasma into 2 x 1 mL aliquots Freeze immediately State on requisition the type of heparin (drug) patient is receiving. TAT– 5 days TEST SPECIFICATION GUIDE – SECTION H Page 4 of 15 CML HealthCare Inc Test Specification Guide 18228 Version: 14.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. $60.00 HLRC TEST NAME CODE **NEW** SPECIMEN REQUIREMENT VACUTAINER BILL LOC HEPATITIS TESTING DETAILS Information pertaining to Hepatitis testing and coding is now displayed with the following set up: � A Quick Reference Coding Sheet which is set up to show: Coding when the Hepatitis request is checked off in the pre-printed section of the OHIP Requisition. Coding when the Hepatitis request is hand written on the OHIP Requisition. AS PRINTED ON THE OHIP REQUISITION Viral Hepatitis (check one only) Acute Hepatitis Chronic Hepatitis (Carrier) Immune status/prev. exposure Specify: Hepatitis A _______ Hepatitis B _______ Hepatitis C ________ HEPATITIS, ACUTE 560 Serum Centrifuge tubes only 2 GOLD SST OHIP CML GOLD SST OHIP CML GOLD SST OHIP CML GOLD SST OHIP CML GOLD SST OHIP CML Label 1 tube autoChem Label 1 tube Hepatitis - Acute TAT – 2 days HEPATITIS, CHRONIC 570 Serum Centrifuge only TAT – 2 days HEPATITIS A 580 IMMUNE STATUS/PREV.EXPOSURE Serum Centrifuge only TAT – 2 days HEPATITIS B 590 IMMUNE STATUS/PREV.EXPOSURE Serum Centrifuge only TAT – 2 days HEPATITIS C IMMUNE STATUS/PREV.EXPOSURE 4037 Serum Centrifuge only TAT – 2 days TEST SPECIFICATION GUIDE – SECTION H Page 5 of 15 CML HealthCare Inc Test Specification Guide 18228 Version: 14.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE HEPATITIS A ANTIBODY IgG 4612 (Anti-HAA IgG) (Anti-HAV IgG) (Anti-HAV) (Havab (HAVAB)) (Hep A Ab (IgG)) SPECIMEN REQUIREMENT Serum Centrifuge only VACUTAINER BILL LOC GOLD SST OHIP CML GOLD SST OHIP CML GOLD SST OHIP CML GOLD SST OHIP CML GOLD SST OHIP CML GOLD SST OHIP CML All markers only 1 FULL tube needed. TAT – 2 days HEPATITIS A ANTIBODY IgM 4613 (Anti-HAV IgM) (HAVAB-M) (Hep A (current infection)) (Hep A (M)) (Hep A AB (IgM)) (Hep A Antibody IgM) (Hep A IgM) HEPATITIS B core ANTIBODY Serum Centrifuge only All markers only 1 FULL tube needed. TAT – 2 days 4609 (AHBC) (Anti-HBc) (B Core) (HbcAb) (Hep B Core Ab) (Hep Bc) (Hep BcAb) Serum Centrifuge only All markers only 1 FULL tube needed. TAT – 2 days HEPATITIS B core IgM ANTIBODY 4614 (AHBC-IgM) (Anti-HBc IgM) (Core IgM) (Hep B Core IgM) Serum Centrifuge only All markers only 1 FULL tube needed. TAT – 2 days HEPATITIS B SURFACE ANTIBODY 4608 (AHBS) (Antibody to Hepatitis B S Ag) (Antibody to Hepatitis B S Antigen) (Anti-HBS) (Anti-HbsAg) (HbsAb) (Hep B Antibodies) (Hep B Surface Ab) (Hep B Surface Ab Titre) (Hep B Surface Antibody) (Hep B Titre) (Post Hepatitis Vaccination) HEPATITIS B SURFACE ANTIGEN (Australian Antigen) (B Surface Antigen) (B. Antigen) (HbsAg) (Hep B S Ag) Serum Centrifuge only All markers only 1 FULL tube needed. TAT – 2 days 4607 Serum Centrifuge only All markers only 1 FULL tube needed TAT – 2 days TEST SPECIFICATION GUIDE – SECTION H Page 6 of 15 CML HealthCare Inc Test Specification Guide 18228 Version: 14.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME HEPATITIS Be ANTIBODY CODE 4611 (AHBe) (Anti-Hbe) (Be Antibody) (E Antibody) (HbeAb) (Hep Be Ab) (Hep Be Antibody) HEPATITIS Be ANTIGEN SPECIMEN REQUIREMENT VACUTAINER BILL LOC GOLD SST OHIP CML GOLD SST OHIP CML PLAIN RED N/C PHL N/C PHL GOLD SST OHIP CML PLAIN RED N/C PHL Serum Centrifuge only All markers only 1 FULL tube needed. TAT – 2 days 4610 (Be Antigen) (Hbe Ag) (Hep Be Ag) Serum Centrifuge only All markers only 1 FULL tube needed. TAT – 2 days HEPATITIS B PRENATAL 319–P Do not centrifuge tube (HBsAg Prenatal) (Hepatitis B Prenatal (HBSAG) only) ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM (Maternal Hepatitis B Screening) TAT – 15 days HEPATITIS B VIRUS DNA 9053 (HEPATITIS B VIRAL LOAD) Serum Minimum Volume required: 3 mL 2 red top tubes required PLAIN RED ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 10 days HEPATITIS C ANTIBODY 4037 (Anti-HCV) (HCV) (Hep C) (Hepatitis C Exposure) (Hepatitis C Screen) (Non A and Non B Anti–HCV) HEPATITIS C GENOTYPING (HEPATITIS C PCR) (HEPATITIS C VIRAL LOAD) Serum Centrifuge only All markers only 1 FULL tube needed. TAT – 2 days 9067 Serum Minimum Volume required: 2 mL ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 10 days TEST SPECIFICATION GUIDE – SECTION H Page 7 of 15 CML HealthCare Inc Test Specification Guide 18228 Version: 14.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME HEPATITIS C RNA CODE 9016 SPECIMEN REQUIREMENT VACUTAINER Serum Minimum Volume required: 3 mL Centrifuge and separate within 4 hours MOH Form must include: risk factors, liver functions, current treatment PLAIN RED BILL LOC N/C PHL N/C PHL N/C PHL OHIP CML N/C PHL N/C PHL ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 10 days HEPATITIS D VIRUS ANTIBODY 9041 Do not centrifuge tube PLAIN RED (DELTA AGENT) ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 10 days HEPATITIS E VIRUS ANTIBODY 9081 Do not centrifuge tube PLAIN RED ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 10 days HEROIN 079 Urine 10 mL random urine Submit in a blue top conical tube State under notes and instructions “CHECK FOR HEROIN” TAT – 3 days HERPES SIMPLEX, SEROLOGY IgG 9030 Do not centrifuge tube PLAIN RED ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days HERPES SIMPLEX, VIRAL CULTURE 9030C Swab Use Public Health Virus–SW canister Swab and transport media provided State source ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days TEST SPECIFICATION GUIDE – SECTION H Page 8 of 15 CML HealthCare Inc Test Specification Guide 18228 Version: 14.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME HERPES SIMPLEX, VIRUS PCR CODE 9331 SPECIMEN REQUIREMENT Spinal Fluid VACUTAINER STERILE CONTAINER BILL LOC $160.00 HLRC Accept and container/tube received. Freeze and ship frozen on dry ice. TAT – 4 days HETEROPHILE ANTIBODY 668 (MONO) (MONONUCLEOSIS SCREEN) Serum Centrifuge only GOLD SST OHIP CML LAVENDER OHIP HLRC TAT – 1 day Refer to SOMATOTROPIN HGH (GROWTH HORMONE) (HUMAN GROWTH HORMONE) (SOMATOTROPIN) Refer to 5-HYDROXY-INDOLACETATE 5–HIAA (5–HYDROXY–INDOL ACETATE) (HYDROXYINDOLE) (SEROTONIN METABOLITE) HISTAMINE 9719 Plasma 2 aliquots of 1mL Collect in pre-chilled tubes Avoid hemolysis. Dietary restrictions within 5-hours of collection: Cheese, wine, red meat, spinach, tomatoes. Antihistamine drugs should not be taken within 48-hours prior to collection. FREEZE PLASMA AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 30 to 60 days TEST SPECIFICATION GUIDE – SECTION H Page 9 of 15 CML HealthCare Inc Test Specification Guide 18228 Version: 14.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME HISTOPATHOLOGY CODE 720-1 (PATHOLOGY) (HISTOLOGY) SPECIMEN REQUIREMENT VACUTAINER Tissue BILL LOC OHIP CML The tissue must be placed into a container of sufficient size containing 10 % Neutral Buffered Formalin, which must equal 10-20 times the volume of the specimen 10 % buffered formalin bottles available from the Purchasing Dept. Specimen container must indicate patient name and source of specimen, and one other unique identifier. All Histology specimens must be accompanied by a completed Histopathology Requisition indicating the specimen (organ) site and any relevant clinical information . Follow Irreplaceable Specimen Procedure ▀ LOCATIONS THAT ACCESSION  Place the Form and the specimen in the Histology envelope  Complete the Histology Specimen Log Form ▀ LOCATIONS THAT DO NOT ACCESSION  Place the Histology specimen and the patient’s other related specimens, the OHIP requisition and the Histopathology Requisition in the Histology envelope  Complete the Histology Specimen Log Form Transport specimen with regular pick-up (tote) Do not code the Documentation Fee for this test Use Test Code 720-2 for second specimen, etc. TAT – 10 days HISTONE ANTIBODIES 9703 (ANTI-HISTONE) Serum Minimum Volume required: 2 mL GOLD SST OHIP HLRC PLAIN RED N/C PHL N/C PHL Testing includes IgG and IgM antibodies. FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 60 days HISTOPLASMA ANTIBODY 9017 Do not centrifuge tube ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days HISTOPLASMA CULTURE (HISTOPLASMA CAPSULATUM) 9018 Sputum Deep cough specimen in sterile container ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days TEST SPECIFICATION GUIDE – SECTION H Page 10 of 15 CML HealthCare Inc Test Specification Guide 18228 Version: 14.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE VACUTAINER BILL LOC N/C PHL N/C PHL N/C PHL N/C PHL URINE TESTING NO LONGER AVAILABLE HISTOPLASMA HIV SPECIMEN REQUIREMENT 9096 (AIDS) (HIV ROUTINE) (HIV SEROLOGY) Do not centrifuge tube PLAIN RED ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days HIV Genotyping can be ordered as a follow up to a positive Viral load result. HIV GENOTYPING The physician must directly notify MOH and send the appropriate form to have this test performed. The test will be performed from the viral load samples held by Public Health. TAT – 1 month HIV IMMIGRATION AND INSURANCE HIV PCR TEST NO LONGER AVAILABLE 9099 Blood LAVENDER & Arrangements must be made with HIV lab PLAIN RED at PHL by telephone BEFORE sending specimens to PHL – Telephone # 416-235-6022 Collect specimen Monday – Wednesday only Complete and label package HIV–PCR STAT DO NOT REFRIGERATE Label lavender tube – HIV–PCR Label plain red tube – HIV ▀ REQUESTING PHYSICIAN MUST PROVIDE A COMPLETED PHL HIV FORM, INDICATING PCR. TAT – 1 month HIV, PRENATAL 9096P Do not centrifuge tube Use this code when blue PHL prenatal form Has HIV box checked PLAIN RED ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days TEST SPECIFICATION GUIDE – SECTION H Page 11 of 15 CML HealthCare Inc Test Specification Guide 18228 Version: 14.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC N/C PHL This test is available only to known positive HIV patients The Viral Load form MUST be completed by the physician Collect test Monday to Wednesday only HIV VIRAL LOAD (VIRAL LOAD) 9097 Blood: 2 x 7 mL PPT Tubes PPT TUBES PHL will not test the specimen without a completed Viral Load Requisition Do not collect the specimen until the requisition is available PHL will not process the specimen without the following information: Health Card number CD4 results Patient name Current therapy Collection Information – complete collection information is required ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM Transport specimen in a test labelled Biohazard Transport Container. Staff collecting sample must fill out collection time and centrifuge time on PHL Form. Centrifuge sample within 4-hours of collection. TAT – 15 days 583 HLA–B27 Blood LAVENDER Collect samples Monday, Tuesday, Wednesday ONLY OHIP HLRC $150.00 HLRC DO NOT REFRIGERATE TAT – 25 days HLA–B27 (PCR) 9196 Blood 3 LAVENDER Minimum volume required: 10mL Collect samples Monday, Tuesday, Wednesday ONLY Form available on CML website. *Only performed when HLA B27 Result is inconclusive DO NOT REFRIGERATE TAT – 30 days HLA– TISSUE TYPING 583T (HLA- TYPING) HISTOCOMPATIBLITY TESTING � For organ/tissue Transplant purposes only Blood 4 LAVENDER OHIP Collect samples Monday – Wednesday ONLY Doctor's name and telephone number must be on the requisition A questionnaire, which is available from the Head Office Problem Solving Department must be completed. Requires clinical information Type of organ transplant, donor’s residency (Ontario Y or N) Place samples, a copy of the OHIP requisition and the questionnaire in a Priority labelled ziplock bag for transport. DO NOT REFRIGERATE TAT – 63 days TEST SPECIFICATION GUIDE – SECTION H Page 12 of 15 CML HealthCare Inc Test Specification Guide 18228 Version: 14.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. HLRC TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC TEST NO LONGER AVAILABLE HLA–B29 HOLTER MONITOR Description Technical (Hook Up) Professional (Reading) 24 Hour Holter G651 G650 48 Hour Holter G682 G658 72 Hour Holter G684 G659 Each code can only be keyed once A combination of each set of codes will be used for each holter dependent upon the requesting physician and the location protocol Refer to the location protocol for the Group Billing Code and Reading Physician code HOMOCYSTEINE 9142 Plasma Minimum Volume required: 2 mL Centrifuge and separate immediately Fasting sample preferred LAVENDER $65.00 CML OHIP DYN OHIP HLRC FREEZE PLASMA AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT –5 days HOMOGENTISATE 123 (HOMOGENSTISIC ACID) Urine 25 mL random urine, freeze within 30 minutes of collection Submit in a 90 mL orange cap container FREEZE URINE AND SEND FROZEN TAT – 20 days HOMOVANILLATE (HOMOVANILLIC ACID) (HVA) 101U 24-Hour Urine 50 mL aliquot – submit in a 90 mL white cap container Do NOT add acid; pH will be adjusted in Biochemistry Dept. State total 24-hour volume on the OHIP Requisition, on the specimen container and in “Notes & Instructions”. Retain a duplicate 50 mL sample in the fridge until test is reported. TAT – 25 days H. PYLORI Refer to HELICOBACTER PYLORI (H. PYLORI ANTIBODY) (HELICOBACTER PYLORI) HUMAN CHORIONIC GONADOTROPIN Refer to CHORIOGONADOTROPIN (BHCG) (HCG, PREGNANCY) HUMAN GROWTH HORMONE Refer to SOMATOTROPIN (GROWTH HORMONE) (HGH) TEST SPECIFICATION GUIDE – SECTION H Page 13 of 15 CML HealthCare Inc Test Specification Guide 18228 Version: 14.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE HUMAN PAPILLOMA VIRUS HPV (HPV) SPECIMEN REQUIREMENT VACUTAINER BILL LOC OHIP DYN OHIP DYN OHIP DYN HPV testing has been suspended. Testing using the Surepath collection method is not currently available. Refer to TU-2014-01 for further information **Physicians are to call Client Services at 1-800-263-0801 x 2 to obtain a Digene HPV kit and LifeLabs requisition.** Refer to ECHINOCOCCOSUS ANTIBODY HYDATID (ECHINOCOCCOSUS ANTIBODY) (ECHINOCOCCUS GRANULOSUS ANTIBODY) Refer to CALCIDIOL 25–HYDROXY VITAMIN D (25-HYDROXYVITAMIN D) (VITAMIN D) (CALCIDIOL) TEST NO LONGER AVAILABLE 17–HYDROXYCORTICOSTEROIDS (17–OH STEROIDS) 5–HYDROXY–INDOLE ACETATE 122 (5-HIAA) (HYDROXYINDOLE) (SEROTONIN METABOLITE) 24-Hour Urine 50 mL aliquot – submit in a 90 mL white cap container Do NOT add acid. pH will be adjusted in Biochemistry Dept. State total 24-hour volume on the OHIP requisition, on the specimen container and in “Notes and Instructions”. Retain a duplicate 50 mL sample in the fridge until test is reported. Refrigerate during storage and transport TAT – 30 days 17–HYDROXY– PROGESTERONE 333 Serum 1 mL aliquot Submit in plastic transfer tube TAT – 25 days 131U 24-Hour Urine 50 mL aliquot – submit in a 90 mL white cap container No preservative (17 OH PROGESTERONE) (PREGNANETRIOL) HYDROXYPROLINE, FREE GOLD SST A controlled diet free of gelatin and low in collagen is required. Avoid meat, fish, jam, ice cream for 1 day prior to, and day of collection. Refrigerate during storage and transport. State total 24-hour volume on the OHIP requisition, on the specimen container and in “Notes and Instructions” Retain a duplicate 50 mL sample in the fridge until test is reported. TAT – 20 days TEST SPECIFICATION GUIDE – SECTION H Page 14 of 15 CML HealthCare Inc Test Specification Guide 18228 Version: 14.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME HYDROXYPROLINE, TOTAL CODE 130U SPECIMEN REQUIREMENT VACUTAINER 24-Hour Urine 50 mL aliquot – submit in a 90 mL white cap container No preservative A controlled diet free of gelatin and low in collagen is required. Avoid meat, fish, jam, ice cream for 1 day prior to, and day of collection. Refrigerate during storage and transport. State total 24-hour volume on the OHIP requisition, on the specimen container and in “Notes and Instructions” Retain a duplicate 50 mL sample in the fridge until test is reported. TAT – 20 days 5–HYDROXYTRYTAMINE Refer to SEROTONIN (SEROTONIN) 25–HYDROXY VITAMIN D Refer to CALCIDIOL (VITAMIN D) (CALCIDIOL) TEST SPECIFICATION GUIDE – SECTION H Page 15 of 15 CML HealthCare Inc Test Specification Guide 18228 Version: 14.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. BILL LOC OHIP DYN TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL 9929 Plasma Minimum Volume required: 3 mL GREEN – with Heparin $60.00 IBUPROFEN (MOTRIN) LOC HLRC TAT – 15 days IGG SUBCLASSES Refer to IMMUNOGLOBULIN G SUB CLASSES (IMMUNOGLOBULIN G SUB CLASSES) IL28B PANEL 9289 (INTERLEUKIN 28B GENOTYPE TOTAL) (HCV RESISTANCE) (HEPATITIS C RESISTANCE) (HEPATITIS C GENOTYPING IL28B) Whole Blood - EDTA Minimum Volume required: 5 mL Store and ship refrigerated LAVENDER $200.00 BAGL LAVENDER $160.00 BAGL Test Includes variants: RS12979860 RS8099917 RS12980275 TAT – 14 days IL28BRS12979860 9290 Whole Blood - EDTA Minimum Volume required: 5 mL Store and ship refrigerated. This test if for single variant RS12979868 TAT – 14 days IMIPRAMINE 079I (TOFRANIL) Serum ROYAL BLUE Minimum Volume required: 2 mL - No Additive Centrifuge and aliquot into serum tube Collect specimen 10 – 12 after last dose Record time in hours that have elapsed between last dose and specimen collection. OHIP DYN OHIP CML Refrigerate during storage and transport. ● Testing Includes Desipramine ● TAT – 20 days IMMUNE COMPLEXES, C1Q Refer to C1Q IMMUNE COMPLEXES (C1Q COMPLEMENT BINDING ACTIVITY) (C1Q IMMUNE COMPLEXEXES) (COMPLEMENT C1Q) IMMUNOELECTROPHORESIS (HEAVY & LIGHT CHAINS IMMUNO) (IMMUNOFIXATION) (GAMMOPATHY TYPING) 575 Serum Centrifuge only GOLD SST TAT – 5 days IMMUNOELECTROPHORESIS Urine Refer to PROTEIN ANALYSIS – BENCE JONES PROTEIN (BENCE JONES PROTEIN) (HEAVY & LIGHT CHAINS IMMUNO) (IEP) TEST SPECIFICATION GUIDE – SECTION I Page 1 of 6 CML HealthCare Inc Test Specification Guide 17530 Version: 6.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE IMMUNOFIXATION SPECIMEN REQUIREMENT VACUTAINER BILL LOC OHIP SBH Refer to IMMUNOELECTROPHORESIS (HEAVY & LIGHT CHAINS IMMUNO) (IMMUNOELECTROPHORESIS) IMMUNOFLUORESCENCE 9757 (I.F.) Tissue Send specimen in an IF Transport Kit Kit available from CML Purchasing department This test is sent to and reported by Sunnybrook Hospital. Complete a Histology Form Send the sample and the form in a Pink Envelope following Irreplaceable Specimen Procedure Place the barcode label in the upper right hand corner of the envelope State Sunnybrook Hospital on the envelope TAT – 20 days IMMUNOGLOBULIN G 9722 SUBCLASSES Serum Fasting preferred GOLD SST $200.00 HLRC (IGG SUBCLASSES) FREEZE AND SEND FROZEN ● Testing Includes IgG1, IgG2, IgG3, and IgG4● TAT – 9 days IMMUNOGLOBULIN G4, SUBCLASS 9588 Serum Fasting preferred GOLD SST $50.00 HLRC GOLD SST OHIP CML GOLD SST OHIP CML GOLD SST OHIP HLRC (IgG4 SUBCLASS) FREEZE AND SEND FROZEN TAT – 9 days IMMUNOGLOBULIN, GAM 550 (IMMUNO GAM) (IMMUNOGLOBULIN, QUANTITATIVE) Serum Centrifuge only ● Testing Includes IgA, IgG, & IgM ● TAT – 2 days IMMUNOGLOBULIN, IgA 550A Serum Centrifuge only TAT – 2 days IMMUNOGLOBULIN, IgD 550D Serum Minimum volume required: 1ml Centrifuge and aliquot into serum tube TAT – 7 days TEST SPECIFICATION GUIDE – SECTION I Page 2 of 6 CML HealthCare Inc Test Specification Guide 17530 Version: 6.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME IMMUNOGLOBULIN, IgE CODE 334 SPECIMEN REQUIREMENT Serum Centrifuge only VACUTAINER BILL LOC GOLD SST OHIP CML GOLD SST OHIP CML GOLD SST OHIP CML TAT – 5 days IMMUNOGLOBULIN, IgG 550G Serum Centrifuge only TAT – 2 days IMMUNOGLOBULIN, IgM 550M Serum Centrifuge only TAT – 2 days IMMUNO PHENOTYPING Refer to LYMPHOCYTE MARKERS (LYMPHOCYTE MARKERS) (T & B CELLS) (LYMPHOTYPING) INDERAL Refer to PROPRANOLOL (PROPRANOLOL) INDICANS TEST NO LONGER AVAILABLE INDICES, RBC Refer to COMPLETE BLOOD COUNT (MCV, MCH, MCHC) INDIRECT BILIRUBIN Refer to BILIRUBIN, INDIRECT (UNCONJUGATED BILIRUBIN) INDIRECT COOMBS Refer to ANTIBODY SCREEN (ANTIBODY SCREEN) (REPEAT PRENATAL ANTIBODY SCREEN) INFECTIOUS MONONUCLEOSIS Refer to HETEROPHILE ANTIBODY (MONO) (HETEROPHILE ANTIBODY) INFLUENZA VIRUS A & B ANTIBODY SEROLOGY TESTING NO LONGER AVAILABLE INORGANIC PHOSPHATE Refer to PHOSPHATE (PHOSPHORUS) TEST SPECIFICATION GUIDE – SECTION I Page 3 of 6 CML HealthCare Inc Test Specification Guide 17530 Version: 6.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE INR 445 (INTERNATIONAL NORMALIZED RATIO) (PRO TIME) (PROTHROMBIN TIME) (PT) SPECIMEN REQUIREMENT VACUTAINER Blood Fill tube completely Do not centrifuge BILL LOC OHIP CML OHIP CML GOLD SST OHIP HLRC GOLD SST $80.00 HLRC GOLD SST OHIP CML LIGHT BLUE TAT – 1 day INSULIN Fasting Random 325F 325R Serum GOLD SST Minimum Volume required: 2 mL Patient must fast a minimum of 14 hours for fasting test FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 4 days INSULIN ANTIBODIES 9182 (ANTI-INSULIN) Serum Centrifuge only TAT – 30 days INSULIN-LIKE GROWTH FACTOR 1 9139 (IGF-1) (SOMATOMEDIN-C) Serum Minimum Volume required: 2 mL FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 25 days INSULIN RESPONSE STUDY 325–120 Serum Minimum Volume required: 2 mL Patient must FAST a minimum of 14 hours for test. Collect a fasting SST Give patient 75g glucose drink Collect SST 2 hours after drink given FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 4 days INTEGRATED PRENATAL SCREENING Refer to MATERNAL SCREEN (FIRST or SECOND TRIMESTER SCREENING) (PAPP-A) TEST SPECIFICATION GUIDE – SECTION I Page 4 of 6 CML HealthCare Inc Test Specification Guide 17530 Version: 6.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE INTERSTITIAL CELL STIMULATING HORMONE SPECIMEN REQUIREMENT VACUTAINER BILL LOC GOLD SST OHIP HLRC OHIP CML Refer to LUTEINIZING HORMONE (LH) (LUTEINIZING HORMONE) (LUTROPIN) INTRINSIC FACTOR ANTIBODIES 9183 Serum Centrifuge only (ANTI-INTRINSIC FACTOR) Collect Monday – Wednesday only Refrigerate during storage and transport Patient must not have received any vitamin B12 injections within 24 hours of collection TAT – 30 days IODINE IRON TEST NO LONGER AVAILABLE 139 (IRON BINDING CAPACITY) (IRON SATURATION) (TIBC) (UIBC) (TOTAL IRON BINDING CAPACITY) (TRANSFERRIN SATURATION) Serum Centrifuge only GOLD SST Morning sample preferred ● Testing Includes Iron, TIBC, % Saturation and unsaturated iron (UIBC) ● TAT – 1 day IRON, URINE 139U 24-Hour Urine 50 mL aliquot – submit in a 90 mL white cap container OHIP HLRC N/C LHSC OHIP HLRC State total 24-hour volume on the OHIP requisition, on the specimen container and in “Notes and Instructions”. Retain a duplicate 50 mL sample in the fridge until test is reported. TAT – 20 days IRON, TISSUE 9380 Tissue Enter specimen source required Ie: Liver STERILE CONTAINER FORM AVAILABLE ON CML WEBSITE TAT – 23 days ISLET CELL ANTIBODY (PANCREATIC ISLET CELL ANTIBODIES) (ANTI-ISLET CELL) 9907 Serum GOLD SST Minimum volume required: 2ml FREEZE SERUM AND TRANSPORT FROZEN TAT – 12 days ISONIAZID TEST NO LONGER AVAILABLE TEST SPECIFICATION GUIDE – SECTION I Page 5 of 6 CML HealthCare Inc Test Specification Guide 17530 Version: 6.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME ISOPROPANOL CODE SPECIMEN REQUIREMENT 006I TEST NO LONGER AVAILABLE VACUTAINER (ALCOHOL-ISOPROPYL) TEST SPECIFICATION GUIDE – SECTION I Page 6 of 6 CML HealthCare Inc Test Specification Guide 17530 Version: 6.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. BILL LOC TEST NAME JAK 2 PCR (JAK 2 GENE MUTATION) CODE 9308 SPECIMEN REQUIREMENT Whole Blood A Molecular Hematology form should be completed and submitted along with specimen and requisition. Ship at room temperature. VACUTAINER BILL LAVENDER OHIP Collect samples Monday, Tuesday, Wednesday ONLY FORM AVAILABLE ON CML WEBSITE If patient does not have a health card, there is a $75.00 charge TAT – 13 days JO-1 Refer to EXTRACTABLE NUCLEAR ANTIBODIES (EXTRACTABLE NUCLEAR ANTIBODIES) TEST SPECIFICATION GUIDE – SECTION J Page 1 of 1 CML HealthCare Inc Test Specification Guide 18395 Version: 4.0 2-Nov-13 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. LOC HLRC TEST NAME KARYOTYPING CODE 701A SPECIMEN REQUIREMENT VACUTAINER Blood / Tissue Specimen must be analysed within 24-hours Submit Monday – Wednesday ONLY BILL LOC OHIP VTF OHIP HLRC Requesting physician must provide completed hospital Cytogenetics Form. Follow collection instructions on form. Pre package sample with completed Cytogenetics Form in a zip lock bag with priority label. DO NOT REFRIGERATE TAT - Variable KETONES Refer to ACETONE (ACETONE) 17 KETOGENIC STEROIDS TEST NO LONGER AVAILABLE (17–KGS) 17 KETOSTEROIDS TEST NO LONGER AVAILABLE (17–KS) KLEIHAUER STAIN (NIERHAUS) 431 Blood Minimum Volume required: 3 mL LAVENDER TAT – 30 days TEST SPECIFICATION GUIDE – SECTION K Page 1 of 1 CML HealthCare Inc Test Specification Guide 17755 Version: 1.3 8/19/2011 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE SPECIMEN REQUIREMENT 145 Plasma Minimum Volume required: 2 mL Collect in a pre-chilled tube Fasting specimen preferred. L-LACTATE (LACTATIC ACID) (LACTATE) VACUTAINER BILL LOC GRAY OHIP HLRC GOLD SST OHIP CML OHIP CML OHIP HLRC FREEZE PLASMA AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 15 days LACTATE DEHYDROGENASE 146 (LD) (LDH) Serum Centrifuge only Hemolyzed specimens are not acceptable. TAT – 1 day TEST NO LONGER AVAILABLE LACTATE DEHYDROGENASE, FRACTIONATION (LD ISOENZYMES) (LDH ISOENZYMES) LACTOSE TOLERANCE LAC–3 (LACTOSE ABSORPTION TEST) Blood GRAY Do not separate. Adult dose: 50g lactose dissolved in 300 mL water Child dose: 2 grams lactose per kilogram of body weight to a maximum of 50 g Collect fasting, 1/2, 1, 2, 3 hour samples. TAT – 1 day LAMOTRIGINE 9956 (LAMICTAL) Serum Minimum Volume required: 2 mL PLAIN RED Collect specimen 10 – 12 hours after last dose Record time in hours that have elapsed between last dose and specimen collection. TAT – 20 days LANOXIN Refer to DIGOXIN (DIGITALIS) (DIGOXIN) LAP (LEUCINE AMINOPEPTIDASE) Serum and 24-Hour Urine TEST NO LONGER AVAILABLE LAP Refer to LEUKOCYTE ALKALINE PHOSPHATASE (LEUKOCYTE ALKALINE PHOSPHATASE) (NEUTROPHIL ALKALINE PHOSPHATASE) LARGACTIL Refer to CHLORPROMAZINE (CHLORPROMAZINE) TEST SPECIFICATION GUIDE – SECTION L Page 1 of 7 CML HealthCare Inc Test Specification Guide 17531 Version: 11.0 5-Mar-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC GREEN – with Heparin OHIP CML GOLD SST OHIP CML ROYAL BLUE K2 EDTA OHIP GD OHIP DYN Refer to RHEUMATOID FACTOR LATEX FIXATION (RA) (RA FACTOR) (RA FIXATION) (RHEUMATOID FACTOR) Refer to THYROID RECEPTOR ANTIBODIES LATS (LONG ACTING THYROID STIMULATOR) (TB11) (THROTROPIN BINDING INHIBITING IMMUNOGLOBULIN) (THYROID STIMULATING ANTIBODY) (TRAB) TSH RECEPTOR ANTIBODY Refer to LYMPHOCYTIC CHORIOMENINGITIS ANTIBODY LCM ANTIBODY (LYMPHOCYTIC CHORIOMENINGITIS ANTIBODY) Refer to LACTATE DEHYDROGENASE LDH (LACTATE DEHYDROGENASE) Refer to LACTATE DEHYDROGENASE FRACTIONATION LDH ISOENZYMES (LD ISOENZYMES) (LACTATE DEHYDROGENASE FRACTIONATION) Refer to LIPID FASTING/LIPID NON FASTING LDL CHOLESTEROL (HDL/LDL CHOLESTEROL) L.E. CELL PREPARATION 430 Blood Do not remove plasma from cells TAT – 1 day L.E. SCREEN 500LE (LE LATEX) (LUPUS ERYTHEMATOSUS SCREEN) Serum Centrifuge only TAT – 1 day LEAD 148 Whole Blood Do not centrifuge TAT – 14 days LEAD 148U 24-Hour Urine 50 mL aliquot submitted in a white cap container State total 24-hour volume on the OHIP requisition, on the specimen container and in “Notes and Instructions”. Retain a duplicate 50 mL sample in the fridge until test is reported. Refrigerate during storage and transport. TAT – 20 days TEST SPECIFICATION GUIDE – SECTION L Page 2 of 7 CML HealthCare Inc Test Specification Guide 17531 Version: 11.0 5-Mar-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME LEGIONELLA DETECTION CODE 9085 SPECIMEN REQUIREMENT Do not centrifuge tube VACUTAINER BILL LOC PLAIN RED N/C PHL N/C PHL (LEGIONAIRES DISEASE) ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days LEPTOSPIRA ANTIBODY 9056 (LEPTOSPIROSIS ANTIBODIES) (WEIL’S DISEASE) Do not centrifuge tube PLAIN RED ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days LEPTOSPIROSIS, URINE NO LONGER AVAILABLE LEUCINE AMINOPEPTIDASE Serum and 24-hour urine NO LONGER AVAILABLE (LAP) LEUKOCYTE ALKALINE PHOSPHATASE NO LONGER AVAILABLE (LAP) (NEUTROPHIL ALKALINE PHOSPHATASE) LEUKOCYTE COUNT Refer to COMPLETE BLOOD COUNT (WBC) LH Refer to LUTEINIZING HORMONE (LUTEINIZING HORMONE) (INTERSTITIAL CELL STIMULATION HORMONE) LIBRIUM Refer to CHLORDIAZEPOXIDE (CHLORDIAZEPOXIDE) LICE Refer to ARTHROPOD IDENTIFICATION (ARTHROPODS) (BUGS) LIGHT CHAINS IMMUNOELECTROPHORESIS Refer to PROTEIN ANALYSIS – BENCE JONES PROTEIN (BENCE JONES PROTEIN) (HEAVY & LIGHT CHAINS IMMUNOELECTROPHORESIS) (IEP) LIGHT CHAINS IMMUNOELECTROPHORESIS Refer to IMMUNOELECTROPHORESIS (HEAVY & LIGHT CHAINS IMMUNOELECTROPHORESIS) TEST SPECIFICATION GUIDE – SECTION L Page 3 of 7 CML HealthCare Inc Test Specification Guide 17531 Version: 11.0 5-Mar-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE 150 LIPASE SPECIMEN REQUIREMENT VACUTAINER BILL LOC GOLD SST OHIP CML Serum Centrifuge only TAT – 4 days 117F LIPID ASSESSMENT, FASTING Serum GOLD SST OHIP CML Centrifuge only Patient has fasted 10 hours or more. Ask Patient “When did you last have something to eat or drink other than water?” Document number of hours on the requisition. Drop offs/hubbing– Document “Drop off” instead of number of hours. Test includes: Cholesterol Fasting Triglycerides HDL-C LDL-C Cholesterol/HDL-C Ratio Non HDL-C TAT – 1 Day 117NF LIPID ASSESSMENT, NON FASTING Serum GOLD SST OHIP CML Centrifuge only. Patient has fasted less than 10 hours. Ask Patient “When did you last have something to eat or drink other than water?” Document number of hours on the requisition. Drop offs/hubbing – Document “Drop off” instead of number of hours. Test includes: Cholesterol Non Fasting Triglycerides HDL-C LDL-C Cholesterol/HDL-C Ratio Non HDL-C TAT – 1 Day NO LONGER AVAILABLE LIPIDS, TOTAL LIPOPROTEIN a 9137 Serum FASTING REQUIRED (12 HOURS) PLAIN RED Minimum Volume required: 1 mL Separate within 4 hours FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT –30 days TEST SPECIFICATION GUIDE – SECTION L Page 4 of 7 CML HealthCare Inc Test Specification Guide 17531 Version: 11.0 5-Mar-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. $35.00 HLRC TEST NAME CODE LIPOPROTEIN FRACTIONATION SPECIMEN REQUIREMENT VACUTAINER BILL LOC OHIP CML OHIP HLRC TEST NO LONGER AVAILABLE (LIPOPROTEIN PHENOTYPING WITH ELECTROPHORESIS) LIQUID BASED PAP SMEAR Refer to CYTOLOGY, PAP SMEAR LISTERIA ANTIBODY TEST NO LONGER AVAILABLE LITHIUM 157 Serum GOLD SST Centrifuge only Collect specimen 10 – 12 hours after last dose Record time in hours that have elapsed between last dose and specimen collection. TAT – 1 day L.M.W. HEPARIN Refer to HEPARIN LOW MOLECULAR WEIGHT LONG ACTING THYROID STIMULATOR Refer to THYROID RECEPTOR ANTIBODIES (LATS) (TB11) (THYROTROPIN BINDING INHIBITING IMMUNOBLOBULIN) (THYROID STIMULATING ANTIBODY) LORAZEPAM 9706 (ATIVAN) Serum PLAIN RED Minimum Volume required: 1 mL Collect specimen 10 – 12 hours after last dose Record time in hours that have elapsed between last dose and specimen collection. FREEZE AND SEND FROZEN TAT – 20 days TEST NO LONGER AVAILABLE LORAZEPAM, urine (ATIVAN) LP-PLA2 (PLAC) (LIPOPROPROTEIN ASSOCIATED PHOSPHOROUS A2) (LP-PLAC2) (LP-PLAC) 9292 Plasma LAVENDER Collect lavender and mix by inversion. Centrifuge and aliquot plasma. Store and ship refrigerated TAT-17 days LUDIOMIL Refer to MAPROTILINE (MAPROTILINE) TEST SPECIFICATION GUIDE – SECTION L Page 5 of 7 CML HealthCare Inc Test Specification Guide 17531 Version: 11.0 5-Mar-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. $75.00 LL TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL 9104 Plasma Minimum Volume required: 2 mL LIGHT BLUE OHIP HLRC (CIRCULATING ANTICOAGULANT) (NON SPECIFIC COAGULATION INHIBITORS) Separate immediately GOLD SST OHIP CML OHIP CML LUPUS ANTICOAGULANT LOC Patient should not be on anticoagulant therapy. FREEZE PLASMA AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 25 days LUTEINIZING HORMONE 328 (LH) (INTERSTITIAL CELL STIMULATING HORMONE) (LUTROPIN) Serum Centrifuge only TAT – 1 day Refer to FLUVOXAMINE LUVOX (FLUVOXAMINE) Refer to BORRELIA BURGDORFERI ANTIBODY LYME DISEASE (BORRELIA BURGDORFERI) LYMPHOCYTE MARKERS, T CELLS ONLY 2810 Blood LAVENDER Submit the specimen Monday – Wednesday, Thursday if Friday is not a statuory holiday. Store and Transport at room temperature Complete a CML “Lymphocyte Marker T Cells only Form” (CD3, CD4, CD8) (T CELL LYMPHOCYTE MARKER ONLY) Specimen must be tested within 24-hours. FOR ALL OTHER MARKERS SEE –LYMPOHCYTE MARKERS, T & B CELLS TAT – 3 days LYMPHOCYTE MARKERS � T & B CELLS (ACUTE LEUKEMIA PHENOTYPING) (LYMPHOPROLIFERATIVE DISEASE PHENOTYPING) 9326 Blood 2 LAVENDERS OHIP Store and ship room temp Collect specimen Monday – Wednesday only prior to last courier pick up The specimens must be accompanied by: Mount Sinai Hosptial Flow Cytometry Requisition available from Problem Solving Department and a photocopy of a physician signed OHIP requisition requesting Lymphocyte Marker analysis with diagnosis indicated. Specimens MUST be tested within 24-hours. TAT – 20 days TEST SPECIFICATION GUIDE – SECTION L Page 6 of 7 CML HealthCare Inc Test Specification Guide 17531 Version: 11.0 5-Mar-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. MSH TEST NAME LYMPHOCYTIC CHORIOMENINGITIS ANTIBODY CODE 9066 SPECIMEN REQUIREMENT Do not centrifuge tube VACUTAINER BILL LOC PLAIN RED N/C PHL N/C PHL ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM (LCM ANTIBODY) TAT – 15 days LYMPHOGRANULOMA VENEREUM GROUP ANTIBODIES 9014 (LGV) Do not centrifuge tube PLAIN RED ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days LYMPHOPROLIFERATIVE DISEASE PHENOTYPING Refer to LYMPHOCYTE MARKERS, T & B CELLS (ACUTE LEUKEMIA PHENOTYPING) (LYMPHOCYTE MARKERS, T & B CELLS) TEST SPECIFICATION GUIDE – SECTION L Page 7 of 7 CML HealthCare Inc Test Specification Guide 17531 Version: 11.0 5-Mar-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME MACROAMYLASE CODE 9135 SPECIMEN REQUIREMENT Serum Centrifuge only VACUTAINER GOLD SST BILL LOC $60.00 HLRC TAT – 20 days MACROGLOBULIN, ALPHA 2 Refer to ALPHA-2 MACROGLOBULIN MACROPROLACTIN 9236 Serum GOLD SST Minimum volume required: 2ml Store and send refrigerated Must be collected in separate SST tube from prolactin test. TAT – 25 days OHIP HLRC MAGNESIUM 165 Serum Centrifuge only GOLD SST OHIP CML GREEN – with Heparin $30.00 HLRC OHIP DYN TAT – 1 day MAGNESIUM, RBC 165R Blood TAT – 20 days MAGNESIUM 24 HOUR URINE 165U 24-Hour Urine 50 mL aliquot – submit in a 90 mL white cap container No preservative Refrigerate during storage and transport. State total 24-hour volume on the OHIP requisition, on the specimen container and in “Notes and Instructions”. Retain a duplicate 50 mL sample in the fridge until test is reported. TAT – 20 days MAGNESIUM RANDOM URINE 165RU Random Urine 10 mL aliquot – submit in a 90 mL orange cap container TAT – 8 days OHIP HLRC MALARIA 432 Blood OHIP CML LAVENDER (PLASMODIUM SCREEN) If test is ordered on a child, may substitute finger prick blood. Prepare 3 thin smears PRIORITY SPECIMEN – Must be processed within 1 hour of receipt at laboratory. TAT – 1 day TEST SPECIFICATION GUIDE – SECTION M Page 1 of 10 CML HealthCare Inc Test Specification Guide 18162 Version: 16.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE MANGANESE 9930 SPECIMEN REQUIREMENT VACUTAINER Plasma Min volume req’d: 3 mL Collect blood in a contaminant-free Royal Blue top K2EDTA. Separate plasma within 30min into Metal-free polypropylene tube. Do not Use gel-seperator collection tubes. ROYAL BLUE K2 EDTA BILL LOC $60.00 HLRC $60.00 HLRC OHIP DYN TAT – 14 days MANGANESE 9931 Urine 25 mL random urine Submit in a 90 mL orange cap container TAT – 20 days MAPROTILINE (LUDIOMIL) 079M Plasma Minimum Volume required: 3 mL GREEN - with Heparin Centrifuge and aliquot into serum tube Collect specimen 10 – 12 hours after last dose Record time in hours that have elapsed between last dose and specimen collection. Refrigerate during storage and transport. TAT – 20 days MARIJUANA Refer to CANNABINOIDS SCREEN (CANNABINOIDS SCREEN) (CANNABIS) (TETRAHYDROCANNOBINOIDS) (THC) MATERNAL SCREEN (DOWN’S SYNDROME SCREEN) (MSS) (TRIPLE MARKER SCREEN) (PAPP A) (INTEGRATED PRENATAL SCREENING) Serum Centrifuge tube only GOLD SST OHIP Requesting physician must provide completed form. The form must accompany the specimen and include responses To specific questions relating to clinical information Place specimen and Form in Priority labelled ziplock bag. Store the name of the test and the testing hospital on the outside Of the ziplock bag. Results will be reported directly to the physician. Testing includes hCG, AFP, uE3 Each hospital must be assigned its specific test code: 944NY North York General Hospital 944MS Mount Sinai Hospital 944CV Credit Valley Hospital 944LH London Health Sciences Centre 944CHEO Children’s Hospital of Easrn Ontario - Ottawa TAT – 15 days TEST SPECIFICATION GUIDE – SECTION M Page 2 of 10 CML HealthCare Inc Test Specification Guide 18162 Version: 16.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. NYGH MSH CVH LHSC CHEO TEST NAME CODE MCV, MCH, MCHC SPECIMEN REQUIREMENT VACUTAINER BILL LOC PLAIN RED N/C PHL $450.00 CML Refer to COMPLETE BLOOD COUNT (INDICES, RBC) MEASLES VIRUS ANTIBODY 9010 (MEASLES – RED) (RUBEOLA) Do not centrifuge tube ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 25 days MELISA – PANEL 1 4383 (MERCURY AND AMALGAM PANEL) Whole Blood – 4 Tubes YELLOW ACD Min Volume: 34ml Collect on Tues, Wed, and Thurs ONLY Do NOT collect on Thurs before a Good Friday. Must be transported to Kennedy within 24-48 hours Store and ship room temp. If a tube only fills half way, take an extra tube to compensate for volume. If patient comes in with other blood work, ACD tubes are last in order of draw. MELISA – PANEL 2 4384 (IMPLANTS PANEL) Whole Blood – 4 Tubes YELLOW ACD Min Volume: 34ml Collect on Tues, Wed, and Thurs ONLY Do NOT collect on Thurs before a Good Friday. $450.00 CML Must be transported to Kennedy within 24-48 hours Store and ship room temp. If a tube only fills half way, take an extra tube to compensate for volume. If patient comes in with other blood work, ACD tubes are last in order of draw. MELISA – PANEL 3 4385 (AUTOIMMUNE/DENTAL/FERTILITY PANEL) Whole Blood – 6 Tubes YELLOW ACD Min Volume: 51ml Collect on Tues, Wed, and Thurs ONLY Do NOT collect on Thurs before a Good Friday. $700.00 CML Must be transported to Kennedy within 24-48 hours Store and ship room temp. If a tube only fills half way, take an extra tube to compensate for volume. If patient comes in with other blood work, ACD tubes are last in order of draw. MELLARIL Refer to THIORIDAZINE (THIORIDAZINE) MEPROBAMATE 9498 (EQUANIL) (MILTOWN) Serum Minimum Volume required: 3 mL PLAIN RED OHIP HLRC OHIP HLRC TAT – 20 days MEPROBAMATE 9498U Urine 50 mL random urine Submit in a 90 mL orange cap container TAT – 20 days TEST SPECIFICATION GUIDE – SECTION M Page 3 of 10 CML HealthCare Inc Test Specification Guide 18162 Version: 16.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME MERCURY – WHOLE BLOOD CODE 168 SPECIMEN REQUIREMENT VACUTAINER BILL LOC ROYAL BLUE K2 EDTA OHIP DYN OHIP DYN OHIP HLRC Whole Blood Do not centrifuge Note: urine is the specimen of choice. Refrigerate during storage and transport. TAT – 25 days MERCURY – 24 HOUR URINE 168U 24-Hour Urine 50 mL aliquot – submit in a 90 mL white cap container No preservative State total 24-hour volume on the OHIP requisition, on the specimen container, and in “Notes and Instructions”. Retain a duplicate 50 mL sample in the fridge until test is reported. TAT – 25 days MERCURY – RANDOM URINE 9358 Random Urine Min Volume: 13ml Collect and transfer into metal-free container Indicate “Random” Provide collection date. Avoid seafood Consumption for 3 days prior to collection. TAT – 14 days METABOLIC SCREEN 9932 Urine 10 mL random urine Submit in a 90 mL white cap container $60.00 HLRC State Date of Birth and clinical diagnosis. Includes: Amino Acid Screen, reducing substances, other chemical tests, Fractionation and Cystine Quantitation will be performed if indicated. FREEZE URINE AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT –15 days METANEPHRINES, PLASMA 9269 Plasma LAVENDER Min volume: 3ml Collect fasting sample. Patient must abstain from smoking for at least 4 hours prior to collection. Store and ship frozen. If specimen thaws, it is unsuitable for analysis. TAT – 14 days TEST SPECIFICATION GUIDE – SECTION M Page 4 of 10 CML HealthCare Inc Test Specification Guide 18162 Version: 16.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. OHIP HLRC TEST NAME METANEPHRINES, FRACTIONATED CODE 170U SPECIMEN REQUIREMENT VACUTAINER 24-Hour Urine 50 mL aliquot – submit in a 90 mL white cap container BILL LOC OHIP DYN (NORMETANEPHRINE) Do NOT add acid; pH will be adjusted in Biochemistry Dept. State total 24-hour volume on the OHIP requisition, on the specimen container and in “Notes and Instructions”. Retain a duplicate 50 mL sample in the fridge until test is reported. Refrigerate during storage and transport. To be avoided for 48 hours before collection: ASA, Chloralhydrate, coffee, cola drinks, dopamine, erythromycin, methyldopa, niacin, phenothiazines, quinidine, quinine, riboflavin, smoking, tea, tetracycline, vitamin B. To be avoided for 72 hours before collection: avacados, bananas, chocolate, eggplant, fruit and juices, hypertensive drugs (esp. Aldomet), pineapple, plums, Tylenol (acetaminophen), walnuts. TAT – 30 days METANEPHRINES, TOTAL METHADONE TEST NO LONGER AVAILABLE 078ME Urine 10 mL random urine Submit in a blue cap conical tube OHIP CML TAT – 3 days METHANOL 006M TEST NO LONGER AVAILABLE (ALCOHOL-METHYL) METHAQUALONE METHEMALBUMIN SCREEN (HAPTOGLOBIN SCREEN) (HEMPEXIN SCREEN) (FREE Hb) (PLASMA HEMOGLOBIN) TEST NO LONGER AVAILABLE 9267 Serum or Plasma GOLD SST Specimen must be received by testing lab within 48 hours of collection. Testing consists of free hb, haptoglobin, hemopexin-heme complex and methemalbumin. TAT – 8 days METHEMOGLOBIN By appointment only at local hospital TEST SPECIFICATION GUIDE – SECTION M Page 5 of 10 CML HealthCare Inc Test Specification Guide 18162 Version: 16.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. OHIP HLRC TEST NAME METHOTREXATE CODE 9729 (AMETHOPTERIN) SPECIMEN REQUIREMENT VACUTAINER Serum PLAIN RED Minimum Volume required: 2 mL Protect from light. Aliquot into amber tube Collect specimen 10 – 12 hours after last dose BILL LOC OHIP HLRC OHIP HLRC $105.00 HLRC OHIP DYN Record time in hours that have elapsed between last dose and specimen collection. Indicate high dose or low dose therapy. TAT – 15 days METHOTRIMEPRAZINE 9163 (NOZINAN) Serum PLAIN RED Minimum Volume required: 3 mL Collect specimen 10 – 12 hours after last dose Record time in hours that have elapsed between last dose and specimen collection. TAT – 15 days METHYLMALONATE 9730 (METHYLMALONIC ACID) Urine 10 mL random urine Submit in a 90 mL orange cap container Early morning specimen preferred. FREEZE URINE AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 35 days METHYLPHENIDATE 9817 (RITALIN) Urine Random urine Submit in a 90 mL orange cap container TAT – 15 days METHYPRYLON 9815 (NOLUDAR) Serum Minimum Volume required: 3 mL PLAIN RED OHIP HLRC TAT – 15 days METHSUXIMIDE (CELONTIN) 9711 Plasma GREEN Minimum Volume required: 2 mL - with Heparin Collect trough specimen 10 – 12 hours after last dose Record time in hours that have elapsed between last dose and specimen collection. TAT – 20 days MEXILETINE NO LONGER AVAILABLE TEST SPECIFICATION GUIDE – SECTION M Page 6 of 10 CML HealthCare Inc Test Specification Guide 18162 Version: 16.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. OHIP HLRC TEST NAME MICROALBUMIN CODE 005U (ALBUMIN, QUANTITATIVE URINE) SPECIMEN REQUIREMENT VACUTAINER 24-Hour Urine CLEAR 1 x 6 mL aliquot – submit in clear cap vacutainer Label tube – MICROALBUMIN No preservative BILL LOC OHIP CML OHIP CML OHIP CML OHIP CML State total 24-hour volume on the OHIP requisition, on the specimen container and in “Notes and Instructions”. Retain a duplicate 90 mL sample in the fridge until test is reported. TAT – 2 days MICROALBUMIN 005RU (ALBUMIN, QUANTITATIVE URINE) Urine CLEAR 6 mL random urine Submit in a clear cap vacutainer Label tube– MICROALBUMIN Submit a separate sample for other urine tests. TAT – 2 days MICROALBUMIN/ CREATININE RATIO � 24-HOUR URINE 3650 24-Hour Urine CLEAR 1 x 6 mL aliquot – submit in clear cap vacutainer Label tube – MICROALBUMIN RATIO No preservative State total 24-hour volume on the OHIP requisition, on the specimen container and in “Notes and Instructions”. Retain a duplicate 90 mL sample in the fridge until test is reported. TAT – 2 days MICROALBUMIN/ CREATININE RATIO � RANDOM URINE 3670 Urine 1 x 6 mL random urine Submit in clear cap vacutainer Label tube – MICROALBUMIN RATIO Testing includes albumin and creatinine CLEAR Submit a separate sample for other urine tests. TAT – 2 days MICROGLOBULIN Refer to BETA-2 MICROGLOBULIN (B2 MICROGLOBULIN) (BETA 2 MICROGLOBULIN) MICROSOMAL THYROID ANTIBODIES Refer to THYROID MICROSOMAL ANTIBODIES (ATA) (ATMA) (ANTI-THYROID ANTIBODY) (MICROSOMAL ANTIBODIES) (THYROGLOBULIN ANTIBODIES) (THYROID ANTIBODIES) TEST SPECIFICATION GUIDE – SECTION M Page 7 of 10 CML HealthCare Inc Test Specification Guide 18162 Version: 16.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE MILTOWN SPECIMEN REQUIREMENT VACUTAINER BILL LOC GOLD SST OHIP CML N/C PHL OHIP CML Refer to MEPROBAMATE (EQUANIL) (MEPROBAMATE) MITOCHONDRIAL ANTIBODIES HP18 (ANTI-MITOCHONDRIAL ANTIBODIES) (ANTI-SMOOTH MUSCLE ANTIBODY) Serum Centrifuge only Positive results may be delayed due to interpretation by Consultant. (ASMA) (SMA) (SMOOTH MUSCLE ANTIBODY) TAT – 2 days MMR 9167 Do not centrifuge tube. PLAIN RED ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM ● Testing includes Mumps, Measles and Rubella Do not code 679 for Rubella. TAT – 15 days MOGADON Refer to NITRAZEPAM (NITRAZEPAM) MONONUCLEOSIS SCREEN Refer to HETEROPHILE ANTIBODY (MONO) (HETEROPHILE ANTIBODY) MORPHINE Refer to DRUG SCREEN – BROAD SPECTRUM (DRUG SCREEN) MOTRIN Refer to IBUPROFEN (IBUPROFEN) MRSA SCREEN TEST (METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS) � � � � AXILLA GROIN NASAL RECTAL 610-1 Swab- state source Place swab in charcoal transport media Use 610-2 for second specimen #2, etc.(up to 5) Storage and transportation at room temperature TAT – 4 days ***IF MRSA ORDERED WITH ANY OTHER SOURCE THAN ABOVE > CODE 628-5 WITH SOURCE AND INDICATE MRSA IN NOTES AND INSTRUCTIONS*** MSS Refer to MATERNAL SCREEN (MATERNAL SERUM SCREEN) (DOWN’S SYNDROME SCREEN) (TRIPLE MARKER SCREEN) TEST SPECIFICATION GUIDE – SECTION M Page 8 of 10 CML HealthCare Inc Test Specification Guide 18162 Version: 16.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE MUCONIC ACID MUCOPOLYSACCHARIDES SPECIMEN REQUIREMENT VACUTAINER BILL LOC TEST NO LONGER AVAILABLE 9732 Urine OHIP HLRC N/C PHL N/C PHL Minimum volume required: 10 mL random urine Submit in a 90 mL orange cap container Avoid first morning collection Provide clinical history FREEZE URINE AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 40 days MULTIMER - VWF Refer to VON WILLEBRAND FACTOR (VON WILLEBRAND FACTOR) MUMPS VIRUS ANTIBODY 9035 Do not centrifuge tube PLAIN RED ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 5 days MURAMIDASE TEST NO LONGER AVAILABLE (LYSOZYME) MYCOBACTERIUM TUBERCULOSIS DETECTION (ACID FAST BACILLUS) (AFB) (T.B. CULTURE) (TUBERCULOSIS CULTURE) 631 Sputum First morning specimen – submit in a tightly sealed sterile container. ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM Use code 631-2 for a second specimen Use code 631-3 for a third specimen DO NOT RINSE MOUTH PRIOR TO COLLECTION TAT – 60 days MYCOPLASMA PNEUMONIAE ANTIBODY SEROLOGY TESTING NO LONGER AVAILABLE TEST SPECIFICATION GUIDE – SECTION M Page 9 of 10 CML HealthCare Inc Test Specification Guide 18162 Version: 16.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME MYCOPLASMA PNEUMONIAE CULTURE CODE 9015C (RESPIRATORY CULTURE) SPECIMEN REQUIREMENT VACUTAINER State source. Nasopharyngeal swab, tracheal aspirate, bronchial washing, auger suction, respiratory tract specimens. Special Mycoplasma transport media available from PHL. BILL LOC N/C PHL OHIP DYN ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days MYCOPLASMA ISOLATION 9122 (UREAPLASMA UREALYTICUM) State source. Swab/Urine/Fluid/Tissue/Semen. Place swab from vagina, cervix or urethra, sediment from centrifuged other fluid, or tissue in special Mycoplasma Transport Media. Break off applicator and replace transport tube cap tightly. Store and ship refrigerated. Do not use swabs with wooden shaft Send Monday, Tuesday, Wednesday only. Urine is to be sent in a sterile container and shipped refrigerated. NO KIT IS NECESSARY FOR URINE. Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 10 days MYELOPEROXIDASE PLASMA 9592 (MPO) Plasma Min volume required: 1 mL LAVENDER $75.00 LL OHIP HLRC TBD HLRC After mixing IMMEDIATELY centrifuge for 10 minutes. IMMEDIATELY aliquot plasma into transfer tube Store and ship refrigerated. TAT – 6 days MYOGLOBIN RANDOM URINE 174 Random urine Min volume required: 10ml Adjust PH of urine to 8-9 and freeze immediately. Specimen is unsuitable for testing if it thaws. TAT – 6 days MYOGLOBIN SERUM 9552 Serum Min volume required: 1ml Centrifuge and aliquot to transfer tube. Store and ship refrigerated. GOLD SST TAT – 13 days MYSOLINE Refer to PRIMIDONE (PRIMIDONE) TEST SPECIFICATION GUIDE – SECTION M Page 10 of 10 CML HealthCare Inc Test Specification Guide 18162 Version: 16.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE 5’ NUCLEOTIDASE N-TERMINAL PROBRAIN NATRIURETIC PEPTIDE SPECIMEN REQUIREMENT VACUTAINER BILL LOC NO LONGER AVAILABLE 9177 (BNP) (NT-PRO) Serum Minimum volume required: 1 mL Centrifuge only GOLD SST $80.00 HLRC Collect Monday – Wednesday only TAT – 15 days NAPROXEN NO LONGER AVAILABLE NARCOTIC SCREEN Refer to DRUGS OF ABUSE (DRUG OF ABUSE) (DRUG SCREEN) (STREET DRUGS) (URINE TOXICOLOGY) NEIRHAUS Refer to KLEIHAUER STAIN (KLEIHAUER STAIN) NEUROMYELITIS OPTIC ANTIBODY (IgG) 9553 Serum GOLD SST Min Volume: 1ml Centrifuge and aliquot into transfer tube. Store and ship frozen. Hemolysed and lipemic specimens are not suitable for testing. TBD HLRC TAT – 24 days NEURONTIN (GABAPENTIN) Refer to GABAPENTIN NEUTROPHIL ALKALINE PHOSPHATASE Refer to LEUKOCYTE ALKALINE PHOSPHATASE (LAP) (LEUKOCYTE ALKALINE PHOSPHATASE) NEUTROPHIL CYTOPLASMIC ANTIBODIES - C 9112 Serum Centrifuge only GOLD SST $75.00 HLRC GOLD SST $75.00 HLRC (c-ANCA) TAT – 15 days NEUTROPHIL CYTOPLASMIC 9148 ANTIBODIES - PERINUCLEAR Serum Centrifuge only (p-ANCA) TAT – 15 days NH 3 Refer to AMMONIA (AMMONIA) TEST SPECIFICATION GUIDE – SECTION N Page 1 of 3 CML HealthCare Inc Test Specification Guide 17533 Version: 2.0 30-Aug-2013 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME NICKEL CODE 9934 SPECIMEN REQUIREMENT VACUTAINER Plasma Centrifuge and pour off into aliquot tube ROYAL BLUE K2 EDTA BILL LOC $60.00 HLRC $60.00 HLRC $60.00 HLRC OHIP HLRC TAT – 30 days NICKEL 9217 Urine 50 mL random urine Submit in a 90 mL orange cap container TAT – 30 days NICOTINE 9238 Urine 10 mL random urine Submit in a 90 mL orange cap container TAT – 15 days NITRAZEPAM (MOGADON) 9126 Serum PLAIN RED Minimum Volume required: 3 mL not SST Centrifuge and aliquot into serum tube Collect trough specimen 10 – 12 hours after last dose FREEZE SERUM AND SEND FROZEN Record time in hours that have elapsed between last dose and specimen collection. TAT – 15 days NITROGEN NO LONGER AVAILABLE NOLUDAR Refer to METHYPRYLON NON–SPECIFIC COAGULATION INHIBITORS Refer to LUPUS ANTICOAGULANT (CIRCULATING ANTICOAGULANT) (LUPUS ANTICOAGULANT) NOREPINEPHRINE Refer to CATECHOLAMINES, FRACTIONATED (CATECHOLAMINES – FRACTIONATED or FREE) NORMETANEPHRINE Refer to METANEPHRINES, FRACTIONATED (METANEPHRINES – FRACTIONATED) NORPACE Refer to DISOPYRAMIDE (DISOPYRAMIDE) NORPRAMINE Refer to DESIPRAMINE (DESIPRAMINE) TEST SPECIFICATION GUIDE – SECTION N Page 2 of 3 CML HealthCare Inc Test Specification Guide 17533 Version: 2.0 30-Aug-2013 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME NORTRYPTYLINE CODE 079N (AVENTYL) SPECIMEN REQUIREMENT VACUTAINER BILL LOC Serum ROYAL BLUE Minimum Volume required: 2 mL - no additive Centrifuge and aliquot into serum tube Collect specimen 10–12 hours after last dose Record time in hours that have elapsed between last dose and specimen collection. OHIP DYN OHIP CML Refrigerate during storage and transport. TAT – 20 days NOZINAN Refer to METHOTRIMEPRAZINE (METHOTRIMEPRAZINE) NT-PRO-BNP NUCLEAR ANTIBODIES (ANA) (ANF) (CENTROMERE ANTIBODY) (SLE ANTIBODIES) Refer to N-TERMINAL PRO BRAIN NATRIURETIC PEPTIDE HP17 Serum Centrifuge only GOLD SST Positive results may be delayed due to interpretation by Consultant TAT – 2 days TEST SPECIFICATION GUIDE – SECTION N Page 3 of 3 CML HealthCare Inc Test Specification Guide 17533 Version: 2.0 30-Aug-2013 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE 17-OH STEROIDS SPECIMEN REQUIREMENT VACUTAINER BILL LOC OHIP CML OHIP CML OHIP HLRC $60.00 HLRC OHIP CML Refer to 17-HYDROXY CORTICOSTEROIDS (17-HYDROXY CORTICOSTEROIDS) 17-OH PROGESTERONE Refer to 17-HYDROXY PROGESTERONE (PREGNANETRIOL) (17-HYDROXY PROGESTERONE) OCCULT BLOOD 181–1 Stool Random specimen Instructions for the patient are in the red kit. Use code 181-2 for second specimen Use code 181-3 for third specimen TAT – 3 days OCCULT BLOOD CANCER CHECK PROGRAMME 179-1 Stool Random specimen Instructions for the patient are in the green kit Use code 179-2 for second specimen Use code 179-3 for third specimen TAT – 3 days OLANZAPINE, SERUM 9957 (ZYPREXA) Serum 1 mL Collect trough sample PLAIN RED FREEZE SERUM AND SEND FROZEN TAT – 14 days OLIGOCLONAL BANDING OLIGOSACCHARIDES Refer to PROTEIN FRACTIONATION, CSF 9936 Urine Submit in a 90 mL orange cap container Avoid first morning collection Provide date of birth, gender and clinical history. FREEZE URINE AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 40 days OPIATES SCREEN 078OP Urine 10 mL random urine Submit in a blue cap conical tube TAT – 10 days TEST SPECIFICATION GUIDE – SECTION O Page 1 of 3 CML HealthCare Inc Test Specification Guide 17759 Version: 4.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME ORGANIC ACIDS CODE 9937 SPECIMEN REQUIREMENT VACUTAINER Urine 10 mL random urine – early morning sample preferred Submit in a 90 mL orange cap container State age of patient and clinical diagnosis BILL LOC OHIP HLRC OHIP HLRC OHIP HLRC OHIP HLRC $60.00 HLRC FREEZE URINE AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 30 days OSMOLALITY 183 Serum Centrifuge only GOLD SST TAT – 15 days OSMOLALITY 183U Urine This code can be used for either a random or a 24-hour urine Submit in a 90 mL orange cap container Retain a duplicate sample in the fridge until the test is reported if the specimen is a 24-hour sample. TAT – 15 days OSMOTIC FRAGILITY 450 Blood LAVENDER Collect specimen before last courier, Monday to Wednesday Keep refrigerated Must be tested within 24-hours TAT – 20 days OSTEOCALCIN 9938 Serum Avoid hemolysis Minimum Volume required: 2 x 1mL Keep aliquots together with elastic band. GOLD SST FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 25 days O’SULLIVAN SCREEN GLUCOSE CHALLENGE Refer to GLUCOSE CHALLENGE (GLUCOSE CHALLENGE O’ SULLIVAN) � 50g glucose load OV 125 Refer to CA125 (CA 125) TEST SPECIFICATION GUIDE – SECTION O Page 2 of 3 CML HealthCare Inc Test Specification Guide 17759 Version: 4.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME OVA AND PARASITES IDENTIFICATION CODE MP66 SPECIMEN REQUIREMENT VACUTAINER Stool Place approximately 1 tablespoon of stool in preservative BILL LOC OHIP CML OHIP HLRC OHIP HLRC OHIP CML $60.00 HLRC (O&P) TAT – 5 days OVARY ANTIBODIES TESTING CURRENTLY NOT AVAILABLE (OVARIAN ANTIBODIES) OXALATE 184U 24-Hour Urine 2 X 10 mL – submit in white cap conical tubes Do NOT add acid; pH will be adjusted in Biochemistry Dept. State total 24-hour volume on the OHIP Requisition, on the specimen container and in “Notes & Instructions” . Retain a duplicate 50 mL sample in the fridge until test is reported. Refrigerate during storage and transport. TAT – 15 days OXAZEPAM 9733 (SERAX) Serum Minimum Volume required: 3 mL PLAIN RED TAT – 15 days OXYCODONE 3195 (PERCODAN) Urine 10 mL random urine Submit in a 10 mL blue top conical tube TAT – 5 days OXYGEN AFFINITY OF HEMOGLOBIN (P50) 9266 Whole Blood LAVENDER Completed form must be submitted with the sample Store and ship at room temperature. FORM AVAILABLE ON CML WEBSITE TAT – 8 days TEST SPECIFICATION GUIDE – SECTION O Page 3 of 3 CML HealthCare Inc Test Specification Guide 17759 Version: 4.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE P– 24, HIV SPECIMEN REQUIREMENT VACUTAINER BILL LOC $145.00 HLRC Refer to HIV (AIDS) (HIV SEROLOGY) PANCREATIC ISLET CELL ANTIBODIES Refer to ISLET CELL ANTIBODY PAPP-A Refer to MATERNAL SCREEN (FIRST or SECOND TRIMESTER SCREENING) (INTEGRATED PRENATAL SCREENING) PAP SMEAR Refer to CYTOLOGY, PAP SMEAR PARAINFLUENZA VIRUS ANTIBODIES NO LONGER AVAILABLE PARANEOPLASTIC AUTOANTIBODY PANEL, SERUM 9277 Serum GOLD SST Minimum Volume required: 1 mL Store and ship at 4-8C TAT – 17 days PARANEOPLASTIC AUTOANTIBODY PANEL, SPINAL FLUID 9285 Spinal Fluid Accept any container received. Minimum Volume required: 1 mL Store and ship at 4-8C. TBD HLRC TAT – 17 days PARASITE SEROLOGY TEST PARATHYROID HORMONE (PTH) (PARATHYRIN) Information regarding requests for specific tests available through CML Consultants 330 Serum PLAIN RED Minimum Volume required: 3 mL Separate within 30 minutes Specimen collected in a SST tube is not acceptable. FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 5 days TEST SPECIFICATION GUIDE – SECTION P Page 1 of 16 CML HealthCare Inc Test Specification Guide 18355 Version: 12.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. OHIP CML TEST NAME CODE PARIETAL CELL ANTIBODIES 9205 SPECIMEN REQUIREMENT VACUTAINER Serum Centrifuge only Refrigerate during storage and transport. BILL LOC GOLD SST OHIP DYN GREEN – with heparin OHIP HLRC $145.00 HLRC LIGHT BLUE OHIP CML PLAIN RED N/C PHL N/C PHL TAT – 25 days PAROXETINE 9940 (PAXIL) Plasma Minimum Volume required: 2 mL FREEZE PLASMA AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 20 days PAROXYSMAL NOCTURNAL HEMOGLOBINURIA 9278 Whole Blood LAVENDER 2 x 5ml lavender top tubes required Requires a lavender tube, unstained slide and latest CBC/diff results. completed immunophenotyping form is required. Specimen must be less than 48 hours old upon receipt. FORM AVAILABLE ON CML WEBSITE TAT – 3 days PARTIAL THROMBOPLASTIN TIME 462 (PTT) (COAGULATION SURFACE INDUCED) Plasma Fill tube completely - Centrifuge FREEZE PLASMA AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 2 day2 PARVO VIRUS 9001 (ERYTHEMA INFECTIOSUM) (FIFTH’S DISEASE) (PARVO VIRUS B19) Do not centrifuge tube State Acute (IgM) or Immune (IgG) ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days PASTEURELLA TULARENSIS ANTIBODY (TULAREMIA) (FRANCISELLA TULARENSIS ANTIBODY) 9024 Do not centrifuge tube PLAIN RED ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 25 days PATERNITY TESTING NO LONGER AVAILABLE TEST SPECIFICATION GUIDE – SECTION P Page 2 of 16 CML HealthCare Inc Test Specification Guide 18355 Version: 12.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE PATHOLOGY SPECIMEN REQUIREMENT VACUTAINER BILL LOC Refer to HISTOPATHOLOGY (HISTOLOGY) PAXIL Refer to PAROXETINE (PAROXETINE) PBG Refer to PORPHOBILINOGEN SCREEN (PORPHOBILINOGEN SCREEN) PCP Refer to PHENCYCLIDINE SCREEN (PHENCYCLIDINE, SCREEN) (ANGEL DUST) PEANUT COMPONENT PANEL 352 Serum 1 SST Required for entire panel. Includes all peanut components. Centrifuge and aliquot Store and ship refrigerated GOLD SST $215.00 HRL $45.00 HRL TAT – 5 days PEANUT COMPONENT TESTING See chart Serum GOLD SST Centrifuge and aliquot Store and ship refrigerated Please free text requested componemt Eg: Peanut rAra h1, Peanut rAra h3 Can have up to 4 components on one accession. If 5 components ordered use test code 352 (Peanut Compontent Panel) TAT – 5 days Test Name  Test Code   Peanut Component‐First Component   Peanut Component‐Second Component   Peanut Component‐Third Component   Peanut Component‐Fourth Component     351‐1   351‐2   351‐3   351‐4   TEST SPECIFICATION GUIDE – SECTION P Page 3 of 16 CML HealthCare Inc Test Specification Guide 18355 Version: 12.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME PEMPHIGUS/PEMPHIGOID ANTIBODIES CODE 9391 SPECIMEN REQUIREMENT VACUTAINER Serum Centrifuge only GOLD SST BILL LOC OHIP HLRC OHIP CML (ANTI-SKIN ANTIBODIES) (EPIDERMAL ANTIBODIES) (SKIN ANTIBODIES) TAT – 25 days PENTOBARBITAL NO LONGER AVAILABLE PH, STOOL NO LONGER AVAILABLE PHENCYCLIDINE SCREEN 078PH (PCP) (ANGEL DUST) Urine 10 mL random urine Submit in a blue top conical tube Indicate in “Notes and Instructions” - “CHECK FOR PHENCYCLIDINE” TAT – 5 days PHENOBARBITAL 081 Serum PLAIN RED Centrifuge only Collect trough specimen 10 – 12 hours after last dose Record time in hours that have elapsed between last dose and specimen collection. OHIP CML TAT – 1 day PHENOL NO LONGER AVAILABLE (BENZENE) PHENOTHIAZINES SCREEN 9259 PHENYLALANINE PHENYTOIN (DILANTIN, FREE) OHIP HLRC REFER TO AMINO ACIDS - QUANTITAVIVE 324 Serum PLAIN RED Minimum Volume required: 2 mL Collect trough specimen 10 – 12 hours after last dose Record time in hours that have elapsed between last dose and specimen collection. TAT – 1 day OHIP CML 9169 Serum PLAIN RED Minimum Volume required: 2 mL Collect trough specimen 10 – 12 hours after last dose Record time in hours that have elapsed between last dose and specimen collection. OHIP HLRC (DILANTIN) PHENYTOIN, FREE Urine Min volume required: 10ml random sample TAT – 5 days TAT – 15 days TEST SPECIFICATION GUIDE – SECTION P Page 4 of 16 CML HealthCare Inc Test Specification Guide 18355 Version: 12.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME PHL TEST NOT ON FILE CODE 9580 SPECIMEN REQUIREMENT VACUTAINER SPECIMEN TYPE WILL VARY VARIES BILL LOC N/C PHL OHIP CML OHIP CML OHIP CML TEST MUST BE SPECIFIED Use this test for PHL tests that are not on file DO NOT use 99999 for not-on-file PHL tests PHOSPHATASE ACID, PROSTATIC NO LONGER AVAILABLE PHOSPHATASE ACID, TOTAL NO LONGER AVAILABLE PHOSPHATASE ALKALINE Refer to ALKALINE PHOSPHATASE (ALKALINE PHOSPHATASE) (ALP) PHOSPHATASE ALKALINE ISOENZYME Refer to ALKALINE PHOSPHATASE FRACTIONATION (ALKALINE PHOSPHATASE ISOENZYME) (ALKALINE PHOSPHATASE FRACTIONATION) PHOSPHATE 194 (PHOSPHORUS) (INORGANIC PHOSPHATE) Serum Centrifuge only GOLD SST TAT – 1 day PHOSPHATE 194U (PHOSPHORUS) 24-Hour Urine 10 mL aliquot – submit in a white cap conical tube No preservative State total 24-hour volume on the OHIP Requisition, on the specimen container and in “Notes & Instructions” Retain a duplicate 90 mL sample in the fridge until test is reported. TAT – 2 days PHOSPHOLIPIDS PHOSPHORUS, URINE (PHOSPHATE RANDOM URINE) NO LONGER AVAILABLE 194RU Urine 10 mL random urine Submit in a white cap conical tube TAT – 2 days TEST SPECIFICATION GUIDE – SECTION P Page 5 of 16 CML HealthCare Inc Test Specification Guide 18355 Version: 12.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME PHYTANATE CODE SPECIMEN REQUIREMENT 9734 Plasma Minimum Volume required: 2 mL Fasting sample preferred (PHYTANIC ACID) VACUTAINER GREEN – with Heparin BILL LOC $60.00 HLRC OHIP CML OHIP HLRC FREEZE PLASMA AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 25 days PINWORM PREPARATION MP80 Paddle – State Source Obtain specimen from perianal area Recommend specimen be obtained early morning prior to washing due to nighttime migration of pinworm. Use code MP81 for a second specimen Use code MP82 for a third specimen TAT – 2 days PK SCREEN Refer to PYRUVATE KINASE (PYRUVATE KINASE) PKU (PHENYLKETONURIA) NO LONGER AVAILABLE send patient to hospital PLACIDYL NO LONGER AVAILABLE (ETHCHLORVYNOL) PLASMA HEMOGLOBIN Refer to HEMOGLOBIN PLASMA (FREE HEMOGLOBIN) PLASMINOGEN 9735 Plasma Minimum Volume required: 1 mL LIGHT BLUE FREEZE PLASMA AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 15 days PLASMODIUM SCREEN Refer to MALARIA PLATELET COUNT Refer to COMPLETE BLOOD CONT (THROMBOCYTE) TEST SPECIFICATION GUIDE – SECTION P Page 6 of 16 CML HealthCare Inc Test Specification Guide 18355 Version: 12.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME PLATELET COUNT, CITRATE SAMPLE CODE 393 SPECIMEN REQUIREMENT VACUTAINER Blood LIGHT BLUE & Label both samples– platelet count LAVENDER Elasticise the two tubes together for transport. BILL LOC OHIP CML N/C PHL $25.00 HLRC OHIP HLRC OHIP DYN TAT – 1 day PLATELET ANTIBODY SCREEN TESTING NO LONGER AVAILABLE (ANTI-PLATELET ANTIBODY) (PLATELET ASSOCIATED IGG) PLATELET FUNCTION TEST By appointment only at hospital POLIO VIRUS Stool/ Throat Swab/ Rectal Swab Viral history sheet must be completed Stool is the preferred sample 9026 9031 9031 Use the correct transport media Stool – VIRUS – TM Throat Swab – VIRUS – SW Rectal Swab – VIRUS – SW ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 to 30 days PORPHOBILINOGEN DEAMINASE 9525 Whole Blood GREEN Min Volume: 7ml - Heparinized SST tube not acceptable. Do not freeze. Store and send refrigerated. Provide haematocrit result for calculation of results. TAT – 14 days PORPHOBILINOGEN SCREEN 197 (PBG) Urine 25 mL random urine Protect from light by wrapping with aluminium foil. Label container with one barcode; wrap container with foil. Place another label with barcode on top of foil overwrap. FREEZE URINE AND SEND FROZEN TAT – 30 days PORPHYRINS, BLOOD PORPHYRINS, QUALITATIVE Refer to PROTOPORPHYRIN 200S Stool 50 g (app. ½ tablespoon) random stool specimen Protect from light by wrapping with aluminium foil. FREEZE STOOL AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 30 days TEST SPECIFICATION GUIDE – SECTION P Page 7 of 16 CML HealthCare Inc Test Specification Guide 18355 Version: 12.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE PORPHYRINS, QUANTITATIVE 203 SPECIMEN REQUIREMENT VACUTAINER Stool 50 g (approximately ½ tablespoon) random stool. Protect from light by wrapping in aluminium foil BILL LOC OHIP DYN OHIP DYN Note: Quantitation performed only if qualitative screen is positive. FREEZE STOOL AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 30 days PORPHYRINS, QUANTITATIVE 201U (COPROPORPHYRINS) (UROPORPHYRINS) 24-Hour Urine 50 mL aliquot – submit in a 90 mL white cap container Keep refrigerated during collection Protect from light by wrapping with aluminium foil. Preservative: sodium carbonate to be added by Biochemistry Dept. State total 24-hour volume on the OHIP Requisition, on the specimen container, and in “Notes & Instructions” . Sample Sorting Department to freeze urine and send frozen. Retain a duplicate 50 mL sample in the fridge until test is reported. TAT – 30 days POST VAS Refer to SEMEN ANALYSIS, POST VASECTOMY (SEMEN ANALYSIS, POST VASECTOMY) (SEMEN POST VAS) POTASSIUM, SERUM 204 Serum Centrifuge only Hemolyzed specimens are not acceptable GOLD SST OHIP CML OHIP CML OHIP CML TAT – 1 day POTASSIUM, 24 HOUR URINE 204U 24-Hour Urine 10 mL aliquot – submit in a white cap conical tube No preservative Testing includes urine creatinine and total volume State total 24-hour volume on the OHIP Requisition, on the specimen container and in “Notes & Instructions” . Retain a duplicate 50 mL sample in the fridge until test is reported. TAT – 2 days POTASSIUM, RANDOM URINE 204RU Urine 10 ml random urine Submit in a white cap conical tube TAT – 2 days POTASSIUM TEST NO LONGER AVAILABLE TEST SPECIFICATION GUIDE – SECTION P Page 8 of 16 CML HealthCare Inc Test Specification Guide 18355 Version: 12.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE PREALBUMIN 9291 SPECIMEN REQUIREMENT VACUTAINER Serum Minimum volume required: 1ml Centrifuge and aliquot Store and ship refrigerated GOLD SST BILL LOC $20.00 HRLC TAT – 10 days PREGNANCY TEST 655 (CHORIOGONADOTROPIN SCREEN) Urine 10 mL random urine Submit in a 90 mL white cap container First morning specimen preferred OHIP CML N/C PHL N/C PHL TAT – 1 day PREGNANEDIOL Refer to PROGESTERONE (PROGESTERONE) PREGNANETRIOL Refer to 17-HYDROXYPROGESTERONE (17– HYDROXYPROGESTERONE) (17 OH PROGESTERONE) PRE NATAL SCREEN Refer to BLOOD GROUP and Refer to ANTIBODY SCREEN (ABO & Ab SCREEN) (ABO & SCREEN) (TYPE & SCREEN) PRE NATAL SCREEN WITH HIV FOR PHL 9001P Do not centrifuge tube PLAIN RED ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM Complete Prenatal form must be attached Group test includes: Hepatitis B Prenatal Rubella Antibody Prenatal HIV Prenatal PHL Prenatal VDRL TAT – 15 days PRE NATAL SCREEN WITHOUT HIV FOR PHL 9002P Do not centrifuge tube PLAIN RED ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM Complete Prenatal form must be attached Group test includes: Hepatitis B Prenatal Rubella Antibody Prenatal PHL Prenatal VDRL TAT – 15 days TEST SPECIFICATION GUIDE – SECTION P Page 9 of 16 CML HealthCare Inc Test Specification Guide 18355 Version: 12.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME PRIMIDONE CODE 211 (MYSOLINE) SPECIMEN REQUIREMENT VACUTAINER BILL LOC OHIP DYN OHIP HLRC GOLD SST OHIP CML GOLD SST OHIP CML LAVENDER OHIP HLRC $13.00 HLRC Serum PLAIN RED Minimum volume required: 1ml Collect trough specimen 10 – 12 hours after last dose Record time in hours that have elapsed between last dose and specimen collection. TAT – 5 days PROCAINAMIDE 212 (PRONESTYL) Serum PLAIN RED Minimum Volume required: 2 mL Collect trough specimen 10 – 12 hours after last dose Record time in hours that have elapsed between last dose and specimen collection. TAT – 5 days PROGESTERONE 331 (PREGNANEDIOL) Serum Centrifuge only TAT – 1 day PROGRAF Refer to TACROLIMUS (FK–506) (TACROLIMUS) PROLACTIN 332 Serum Centrifuge only TAT – 1 day PRONESTYL Refer to PROCAINAMIDE (PROCAINAMIDE) PROINSULIN 9304 Plasma Minimum Volume required: 2 mL Collect fasting specimen in pre-chilled tube. Chill the whole blood on ice for at least 10 min. Spin down in a refrigerated centrifuge if available. Separate and freeze plasma immediately. TAT – 14 days PROLIFERATING CELL NUCLEAR ANTIBODIES (ANTI – PCNA) 9335 Serum GOLD SST Minimum Volume required: 1 mL Centrifuge, separate into transfer tube and freeze immediately. Store and send frozen. TAT – 24 days TEST SPECIFICATION GUIDE – SECTION P Page 10 of 16 CML HealthCare Inc Test Specification Guide 18355 Version: 12.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME PROPAFENONE CODE SPECIMEN REQUIREMENT VACUTAINER BILL 9943 Plasma Minimum Volume required: 2 mL GREEN – with heparin OHIP HLRC OHIP CML (RYTHMOL) LOC Collect specimen 10 – 12 hours after the last dose Record in hours the time that have elapsed between last dose and specimen collection. Patient should be taking this medication for 3 days prior to testing. Collect Monday – Wednesday only TAT – 15 days PROPOXYPHENE 078PR (DARVON) PROPRANOLOL Urine 10 mL random urine Submit in a blue top conical tube TAT – 7 days NO LONGER AVAILABLE (INDERAL) PROSTATE SPECIFIC ANTIGEN, 354 FREE / TOTAL RATIO - MONITORING (PSA, FREE / TOTAL RATIO) (PSA PERCENT ) Serum GOLD SST OHIP CML Centrifuge within 2-hours of collection Must be tested within 24-hours after collection, or freeze for storage and transport. ● Testing Includes Total PSA ● Patient must meet eligibility criteria for insurable PSA testing TAT – 3 days PROSTATE SPECIFIC ANTIGEN, 9146 FREE / TOTAL RATIO - SCREENING (PSA, FREE / TOTAL RATIO) (PSA PERCENT ) Serum GOLD SST $50.00 CML Centrifuge within 2-hours of collection Must be tested within 24-hours after collection, or freeze for storage and transport. ● Testing Includes Total PSA ● TAT – 3 days PROSTATE SPECIFIC ANTIGEN, 358 TOTAL– MONITORING Serum Centrifuge only GOLD SST (PSA, TOTAL DISEASE STATE) Patient must meet eligibility criteria for insurable PSA testing TAT – 3 days TEST SPECIFICATION GUIDE – SECTION P Page 11 of 16 CML HealthCare Inc Test Specification Guide 18355 Version: 12.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. OHIP CML TEST NAME CODE PROSTATE SPECIFIC ANTIGEN, 358 WITH HETEROPHILE BLOCK SPECIMEN REQUIREMENT VACUTAINER Serum Centrifuge only GOLD SST BILL LOC OHIP CML (PSA WITH HETEROPHILE BLOCK) Physician may request PSA with heterophile block to confirm positive post-prostatectomy PSA only after consultation with Biochemistry manager, Place specimen and OHIP requisition in priority labelled ziplock bag Indicate on priority label: “ATTN: BIOCHEMISTRY MANAGER/SUPERVISOR PSA WITH HETEROPHILE BLOCK” TAT – 3 days PROSTATE SPECIFIC ANTIGEN, 9701 TOTAL– SCREENING ONLY Serum Centrifuge only (PSA SCREEN) (PSA TOTAL) TAT – 3 days PROTEIN ANALYSIS BENCE JONES PROTEIN 575RU (IMMUNOELECTROPHORESIS HEAVY & LIGHT CHAINS BENCE JONES PROTEIN) GOLD SST Urine 50 mL random urine Submit in 90 mL white cap container No preservative First morning specimen preferred $30.00 CML OHIP CML OHIP CML TAT – 5 days PROTEIN ANALYSIS BENCE JONES PROTEIN 575U (BENCE JONES PROTEIN HEAVY & LIGHT CHAINS IMMUNOELECTROPHORESIS) 24-Hour Urine 10 mL aliquot submitted in white cap conical tube labelled CREATININE and 50 mL aliquot submitted in 90 mL white cap container labelled BENCE JONES No preservative State 24-hours total volume on the OHIP requisition, On the specimen and in “Notes and Instructions”. Retain a duplicate 50 mL sample in the fridge until test is reported. TAT – 5 days PROTEIN C ACTIVITY (FUNCTIONAL/IMMUNOLOGICAL) 9971 Plasma (Citrate) Minimum Volume required: 3 mL LIGHT BLUE Coumadin should be restricted for 2 weeks prior to the test. Consult with the patient’s physician before proceeding with the test. Document the call on the OHIP requisition. Separate plasma immediately. FREEZE PLASMA AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 15 to 25 days TEST SPECIFICATION GUIDE – SECTION P Page 12 of 16 CML HealthCare Inc Test Specification Guide 18355 Version: 12.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. $75.00 HLRC TEST NAME CODE PROTEIN ELECTROPHORESIS, CSF PROTEIN FRACTIONATION, CSF SPECIMEN REQUIREMENT VACUTAINER BILL LOC Refer to PROTEIN FRACTIONATION, CSF 9257 (PROTEIN ELECTROPHORESIS - CSF) (OLIGOCLONAL BANDING) Serum Minimum Volume required: 1 mL serum, 5ml CSF RED TUBE OHIP HLRC AND STERILE CONTAINER Serum sample MUST accompany CSF. Serum MUST be collected within 24 hrs of CSF collection. Include collection date, collection time, and Physician’s name on requisition TAT – 11 days PROTEIN FRACTIONATION 085 (PROTEIN ELECTROPHORESIS) (SPE) Serum Centrifuge only GOLD SST OHIP CML OHIP CML $60.00 HLRC ● Testing Includes Total Protein ● TAT – 2 days PROTEIN FRACTIONATION 086 (PEP) (SPE- 24 HOUR) (PROTEIN ELECTROPHORESIS) 24-Hour Urine 10 mL aliquot – submit in a white cap conical tube labelled “CREATININE” and a 50 mL aliquot – submit in a 90 mL white cap container labelled “PEP” No preservative State total 24-hour volume on the OHIP Requisition, on the specimen container and in “Notes & Instructions”. Retain a duplicate 50 mL sample in the fridge until test is reported. ● Testing Includes Total Protein, Urine Creatinine ● TAT – 3 days PROTEIN S, FREE/TOTAL 9479 Plasma Minimum Volume required: 2 mL LIGHT BLUE FREEZE PLASMA AND SEND FROZEN Note: Total analysis will only be performed if Protein S, Free is low (< 0.62 U/mL). NOTE: Patient should not be on anticoagulant therapy Reference range applies to patients 18 year of age and older Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 15 to 25 days PROTEIN S, TOTAL Refer to PROTEIN S, FREE/TOTAL TEST SPECIFICATION GUIDE – SECTION P Page 13 of 16 CML HealthCare Inc Test Specification Guide 18355 Version: 12.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME PROTEIN, TOTAL – FLUID CODE 208FL SPECIMEN REQUIREMENT Fluid – state source Minimum Volume required: 1 mL Submit in plastic transfer tube VACUTAINER BILL LOC PLAIN RED OHIP CML GOLD SST OHIP CML TAT – 1 day PROTEIN, TOTAL – SERUM 208 Serum Centrifuge only TAT – 1 day PROTEIN, TOTAL QUALITATIVE 254– 3 Urine 10 mL random urine Submit in a yellow cap conical tube TAT – 2 days OHIP CML 208RU Urine CLEAR 6 mL random urine Submit in a clear cap vacutainer labelled “PROTEIN” OHIP CML OHIP CML OHIP HLRC (ALBUMIN, QUALITATIVE URINE) PROTEIN, TOTAL QUANTITATIVE TAT – 1 day PROTEIN, TOTAL 24-HOUR URINE 208U 24-Hour Urine 2 CLEAR 10 mL aliquot – submit in a clear cap vacutainer labelled “CREATININE” and a 6 mL aliquot – submit in a clear cap vacutainer labelled “ PROTEIN” No preservative State total 24-hour volume on the OHIP Requisition, on the specimen container and in “Notes & Instructions”. Testing includes urine creatinine and total volume. Retain a duplicate 50 mL sample in the fridge until test is reported. TAT – 2 days PROTHROMBIN GENE MUTATION (FACTOR II PROTHROMBIN MUTATION) 9212 Blood Collect sample Monday – Wednesday only LAVENDER A form for Molecular Genetic DNA Testing must be completed by the doctor and accompany the specimen. Form available from CML Problem Solving Department Keep form and sample together in a Priority labelled zip lock bag Refrigerate during storage and transport. TAT– 30 days PROTHROMBIN TIME Refer to INR (INR) (PRO TIME) (PT) TEST SPECIFICATION GUIDE – SECTION P Page 14 of 16 CML HealthCare Inc Test Specification Guide 18355 Version: 12.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME PROTOPORPHYRINS, RBC CODE 202 SPECIMEN REQUIREMENT VACUTAINER Whole blood Do not centrifuge Protect from light BILL LOC LAVENDER OHIP DYN ROYAL BLUE - no Additives OHIP DYN Refrigerate during storage and transport. TAT – 30 days PROTRIPTYLINE (TRIPTIL) 9433 Serum Minimum Volume required: 3 mL Centrifuge and aliquot into serum tube Collect trough specimen 10 – 12 hours after last dose Record time in hours that have elapsed between last dose and specimen collection. TAT – 20 days PROZAC Refer to FLUOXETINE (FLUOXETINE) PSA, TOTAL Refer to PROSTATE SPECIFIC ANTIGEN (PROSTATE SPECIFIC ANTIGEN, TOTAL– SCREENING ONLY) PSA, FREE / TOTAL RATIO Refer to PROSTATE SPECIFIC ANTIGEN FREE/TOTAL (PROSTATE SPECIFIC ANTIGEN FREE / TOTAL RATIO) (PSA PERCENT %) (PSA FRACTIONATION) PSEUDOCHOLINESTERASE Refer to CHOLINESTERASE, PHENOTYPE PSITTACOSIS ANTIBODY (Chlamydia– Psittaci) Refer to CHLAMYDIA PSITTACI ANTIBODY PT Refer to INR (INR) (PRO TIME) (PROTHROMBIN TIME) PTH Refer to PARATHYROID HORMONE (PARATHYROID HORMONE) (PARATHYRIN) PTT Refer to PARTIAL THROMBOPLASTIN TIME (PARTIAL THROMBOPLASTIN TIME) PYRIDINIUM Refer to DEOXYPYRIDINOLINE TEST SPECIFICATION GUIDE – SECTION P Page 15 of 16 CML HealthCare Inc Test Specification Guide 18355 Version: 12.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME PYRIDOXINE CODE 9379 (PYRIDOXAL PHOASPHATE) (VITAMIN B6) SPECIMEN REQUIREMENT VACUTAINER Plasma LAVENDER Minimum Volume required: 2 mL Separate within 1-hour of collection. Transfer plasma into an amber transport tube to protect from light. BILL LOC $65.00 HLRC OHIP HLRC FREEZE PLASMA AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 40 days PYRUVATE KINASE (PK SCREEN) 9941 Blood LAVENDER Store and send refrigerated Blood transfusion within the last 3 months will invalidate test results TAT – 25 days TEST SPECIFICATION GUIDE – SECTION P Page 16 of 16 CML HealthCare Inc Test Specification Guide 18355 Version: 12.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME QUETIAPINE CODE 9569 (SEROQUEL) SPECIMEN REQUIREMENT VACUTAINER Serum Minimum Volume required: 1 mL PLAIN RED BILL LOC TBD HLRC $35.00 HLRC OHIP HLRC N/C PHL Centrigue and aliquot into transfer tube. Store and ship frozen. Trough specimen required. Do NOT collect in gel seperater (SST) tube TAT – 12 days QUININE 9468U Urine 25 mL random urine Submit in a 90 mL orange cap container TAT – 20 days QUINIDINE 215 (BIQUIN) Serum PLAIN RED Minimum Volume required: 2 mL Collect trough specimen 10 – 12 hours after last dose Record time in hours that have elapsed between last dose and specimen collection. TAT – 3 days Q– FEVER ANTIBODY 9027 Do not centrifuge tube PLAIN RED (COXIELLA BURNETTI ANTIBODY) ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days TEST SPECIFICATION GUIDE – SECTION Q Page 1 of 1 CML HealthCare Inc Test Specification Guide 16914 Version: 2.0 30-Aug-2013 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC Refer to RHEUMATOID FACTOR RA (LATEX FIXATION) (RA FACTOR) (RA FIXATION) (RHEUMATOID FACTOR) RABIES VIRUS ANTIBODY 9070 State if post vaccination Do not centrifuge tube PLAIN RED N/C PHL OHIP DYN ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days Refer to RICKETTSIA ANTIBODY R. AKARI (RICKETTSIA ANTIBODY) (RMSF) (ROCKY MOUNTAIN SPOTTED FEVER) (TYPHUS MURINE ANTIBODY) Refer to SIROLIMUS RAPAMUNE (RAPAMYCIN) (SIROLIMUS) RAST Refer to ALLERGEN TESTING RBC CHOLINESTERASE Refer to ACETYL CHOLINESTERASE (ACETYL CHOLINESTERASE) Refer to MAGNESIUM, RBC RBC MAGNESIUM (MAGNESIUM, RBC) Refer to COMPLETE BLOOD COUNT RED BLOOD CELL COUNT (ERYTHROCYTE COUNT, RBC) Refer to MEASLES VIRUS ANTIBODY RED MEASLES (RUBEOLA) REDUCING SUBSTANCES 216 Stool 5 g (approx. 1 teaspoon) random stool Freeze stool and send FROZEN TAT – 15 days REDUCING SUBSTANCES TEST NO LONGER AVAILABLE REPEAT PRENATAL ANTIBODIES Refer to ANTIBODY SCREEN (ABO & Ab SCREEN) (ABO & SCREEN) (PRENATAL SCREEN) (TYPE & SCREEN) TEST SPECIFICATION GUIDE – SECTION R Page 1 of 4 CML HealthCare Inc Test Specification Guide 16915 Version: 4.0 5-Mar-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME RENIN CODE 9376 (RENIN DIRECT) SPECIMEN REQUIREMENT VACUTAINER BILL LOC Plasma LAVENDER Minimum Volume required: 1 mL Collect at room temperature. Process sample at room temperature. Centrifuge sample in regular centrifuge. Separate as soon as possible after centrifugation. OHIP HLRC GOLD SST $60.00 HLRC LAVENDER OHIP CML GOLD SST OHIP HLRC GOLD SST OHIP CML FREEZE PLASMA AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 25 days Refer to MYCOPLASMA PNEUMONIAE CULTURE RESPIRATORY CULTURE (MYCOPLASMA CULTURE) RETICULIN ANTIBODIES 9942 (ANTI-RETICULIN ANTIBODY) Serum Centrifuge only TAT – 20 days RETICULOCYTE COUNT 398 Blood TAT – 1 day RETINOL 260 (VITAMIN A) Serum Minimum Volume required: 2 mL Avoid hemolysis Protect from light by transferring serum into an amber transport tube Fasting specimen preferred FREEZE SERUM AND SEND FROZEN. TAT – 15 days REVERSE T3 Refer to TRIIODOTHYRONINE REVERSE Rh FACTOR Refer to BLOOD GROUP (TRIIODOTHYRONINE REVERSE) (ABO & TYPE) (ABO RhD) (BLOOD GROUP & Rh(D)) (BLOOD TYPE) RHEUMATOID FACTOR (LATEX FIXATION) (RA) (RA FACTOR) (RA FIXATION) 500RA Serum Centrifuge only TAT – 1 day TEST SPECIFICATION GUIDE – SECTION R Page 2 of 4 CML HealthCare Inc Test Specification Guide 16915 Version: 4.0 5-Mar-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME RICKETTSIA ANTIBODY CODE 9044 (R.AKARI) (RMSF) (ROCKY MOUNTAIN SPOTTED FEVER) (TYPHUS MURINE ANTIBODY) SPECIMEN REQUIREMENT Public Health Laboratory recommends both acute and convalescent specimens taken two weeks apart Do not centrifuge tube VACUTAINER PLAIN RED BILL LOC N/C PHL OHIP HLRC OHIP HLRC N/C PHL ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 45 days Refer to DERMATOPHYTOSIS RINGWORM OF SCALP (DERMATOPHYTOSIS) (WOOD LAMPS TEST) RISPERIDONE 9738 (RISPERDOL) Serum 2mL Trough specimen. Freeze serum and send FROZEN Collect just prior to next dose. Serum from gel separator NOTacceptable PLAIN RED TAT – 15 days RISTOCETIN CO FACTOR VON WILLEBRAND TEST NO LONGER AVAILABLE RITALIN Refer to METHYLPHENIDATE (METHYLPHENIDATE) Refer to CLONZAEPAM RIVOTRIL (CLONAZEPAM) Refer to RICKETTSIAL ANTIBODY ROCKY MOUNTAIN SPOTTED FEVER ANTIBODY (R.AKARI) (RICKETTSIAL ANTIBODY) (RMSF) (TYPHUS MURINE ANTIBODY) ROHYPNOL 9739 (DATE RAPE) (FLUNITRAZEPAM) Urine 10 mL random urine Submit in a 90 mL orange cap container TAT – 15 days IgM Collect specimen 1 to 3 weeks after onset of rash (ACUTE RUBELLA) (RUBELLA IGM) Do not centrifuge tube RUBELLA VIRUS ANTIBODY, 9077 PLAIN RED ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 5 days TEST SPECIFICATION GUIDE – SECTION R Page 3 of 4 CML HealthCare Inc Test Specification Guide 16915 Version: 4.0 5-Mar-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE RUBELLA VIRUS ANTIBODY, IgG 679 (RUBELLA ANTIBODY IGG IMMUNE) (RUBELLA IGG) RUBELLA VIRUS ANTIBODY, IgG PRENATAL SPECIMEN REQUIREMENT Serum Centrifuge only VACUTAINER BILL LOC GOLD SST OHIP CML PLAIN RED N/C PHL TAT – 1 day 679-P Do not centrifuge tube To be sent in conjunction with Prenatal Hepatitis B, VDRL and Prenatal HIV One tube is required for all the tests ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 10 days RUBEOLA Refer to MEASLES VIRUS ANTIBODY (RED MEASLES) RYTHMOL Refer to PROPAFENONE (PROPAFENONE) TEST SPECIFICATION GUIDE – SECTION R Page 4 of 4 CML HealthCare Inc Test Specification Guide 16915 Version: 4.0 5-Mar-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME SALICYLATE CODE 221 (ACETYLSALICYLIC ACID) (ASA) (ASPIRIN) SPECIMEN REQUIREMENT VACUTAINER Serum PLAIN RED Minimum Volume required: 2 mL Record time in hours that have elapsed between last dose and specimen collection. BILL LOC OHIP HLRC TAT – 15 days SCHILLINGS TEST Refer patient to hospital for testing SCL-70 ANTIBODIES Refer to EXTRACTABLE NUCLEAR ANTIBODIES (SCLERODERMAL ANTIBODY) (ANTI SCL-70) SECOBARBITAL 9434 Serum PLAIN RED Minimum Volume required: 3 mL Collect trough specimen 10 - 12 hours after last dose Record time in hours that have elapsed between last dose and specimen collection. OHIP HLRC $45.00 HLRC $60.00 HLRC OHIP CML OHIP CML TAT – 15 days Refer to ERYTHROCYTE SEDIMENTATION RATE SEDIMENTATION RATE (ESR) (SED RATE) SELENIUM 9491 Plasma Minimum Volume required: 3 mL Separate plasma as soon as possible ROYAL BLUE - with K2 EDTA TAT – 25 days SELENIUM 9944 Urine Random 50 mL random urine Submit in 90 mL orange cap container TAT - 25 days SEMEN ANALYSIS, COMPLETE HP12 (FOR FERTILITY) Semen Available only at specific sites by appointment. Patient may call 905-565-0433 to arrange an appointment. Do not code the Documentation Fee for this test. TAT – 4 days Results may be delayed due to confirmation by pathologist SEMEN ANALYSIS, POST VASECTOMY (POST VAS) (SEMEN POST VAS) HP13 Semen Collection instructions and kits available Do not code the Documentation Fee for this test. TAT – 4 days Results may be delayed due to confirmation by pathologist TEST SPECIFICATION GUIDE – SECTION S Page 1 of 5 CML HealthCare Inc Test Specification Guide 18396 Version: 3.0 20-Feb-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC Refer to THYROTROPIN SENSITIVE TSH (THYROTROPIN) (TSH) Refer to OXAZEPAM SERAX (OXAZEPAM) SEROTONIN 9716 (5– HYDROXYTRYTAMINE) Serum GOLD SST 2 aliquots of 1 mL – keep aliquots together with elastic OHIP HLRC For 48-hours prior to collection, patient should abstain from: Avocados, bananas, coffee, plums, pineapple, tomatoes, walnuts, hickory nuts, Mollusks, eggplant, and meds such as aspirin, corticotrophins, MAO inhibitors, phenacetin, catecholamines, reserpine, nicotine FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 35 days Refer to 5-HYDROXYINDOL ACETATE SEROTONIN METABOLITE (5– HIAA) (HYDROXYINDOLE) (5-HYDROXYINDOLE ACETATE) SERTRALINE 9952 (ZOLOFT) Serum PLAIN RED Centrifuge Minimum Volume required: 2 mL aliquot Patient should be on the drug 7 days prior to testing Collect trough specimen 10 – 12 hours after last dose OHIP HLRC $45.00 HLRC OHIP CML Record time in hours that have elapsed between last dose and specimen collection. TAT – 25 days SEX HORMONE BINDING GLOBULIN 9138 Serum Centrifuge only GOLD SST TAT –25 days Refer to ASPARATE AMINO TRANSAMINASE SGOT (AST) (ASPARATE AMINO TRANSAMINASE) Refer to ALANINE AMINO TRANSAMINASE SGPT (ALT) (ALANINE AMINO TRANSAMINASE) SICKLE CELL SCREEN (SICKLE CELL PREP) (SICKLE CELL SOLUBILITY SCREEN) 453 Blood Do not centrifuge LAVENDER TAT – 1 day TEST SPECIFICATION GUIDE – SECTION S Page 2 of 5 CML HealthCare Inc Test Specification Guide 18396 Version: 3.0 20-Feb-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE SPECIMEN REQUIREMENT SILVER, PLASMA TEST NO LONGER AVAILABLE SILVER TEST NO LONGER AVAILABLE SINEQUAN Refer to DOXEPIN VACUTAINER BILL LOC (DOXEPIN) SIROLIMUS 9161 (RAPAMUNE) (RAPAMYCIN) Blood – Whole LAVENDER OHIP HLRC OHIP CML OHIP CML Transplant hospital and Transplant physician MUST be provided on the requisition. Place the specimen and the Hospital Form in a Priority labelled ziplock bag. TAT – 15 days Refer to NUCLEAR ANTIBODIES SLE ANTIBODIES (ANA) (ANF) (ANTI NUCLEAR ANTIBODY) (CENTROMERE ANTIBODY) SMEAR FOR GRAM STAIN Refer to GRAM STAIN SMOOTH MUSCLE ANTIBODIES Refer to MITOCHONDRIAL ANTIBODIES (ANTI-MITOCHONDRIAL ANTIBODIES) (ANTI-SMOOTH MUSCLE ANTIBODY) (ASMA) (MITOCHONDRIAL ANTIBODIES) (SMA) SODIUM, SERUM 226 Centrifuge only Hemolyzed specimens are not acceptable GOLD SST TAT – 1 day SODIUM, 24 HOUR URINE 226U 24-Hour Urine 10 mL aliquot – submit in a white cap conical tube No preservative State total 24-hour volume on the OHIP Requisition, on the specimen container and in “Notes & Instructions” . Retain a duplicate 90 mL sample in the fridge until test is reported. TAT – 2 days TEST SPECIFICATION GUIDE – SECTION S Page 3 of 5 CML HealthCare Inc Test Specification Guide 18396 Version: 3.0 20-Feb-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE SODIUM, URINE 226RU SPECIMEN REQUIREMENT VACUTAINER BILL LOC OHIP CML GOLD SST OHIP CML GOLD SST OHIP DYN Urine 10 mL random urine Submit in a white cap conical tube TAT – 2 days Refer to INSULIN LIKE GROWTH FACTOR 1 SOMATOMEDIN C (IGF) (INSULIN LIKE GROWTH FACTOR 1) SOMATOTROPIN 317 (HUMAN GROWTH HORMONE) (HGH) Serum Minimum volume required: 2 mL Separate within 30 minutes FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines TAT – 10 days Refer to PROTEIN FRACTIONATION SPE (PROTEIN FRACTIONATION) SPERM ANTIBODIES (ANTI-SPERM ANTIBODIES) 597 Serum Centrifuge only Hemolysed samples are NOT acceptable TAT – 30 days SS– A Included in Extractable Nuclear Antibodies Screen (ROSE ANTIBODIES) SS– B Included in Extractable Nuclear Antibodies Screen (LATIMER ANTIBODIES) STONE ANALYSIS Refer to CALCULUS ANALYSIS (CALCULUS ANALYSIS) STOOL, PH Refer to PH STOOL, Refer to REDUCING SUBSTANCES (REDUCING SUBSTANCES) STREET DRUGS Refer to DRUGS OF ABUSE (DRUGS OF ABUSE) (DRUGS SCREEN) (NARCOTIC SCREEN) (URINE TOXICOLOGY) TEST SPECIFICATION GUIDE – SECTION S Page 4 of 5 CML HealthCare Inc Test Specification Guide 18396 Version: 3.0 20-Feb-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE VACUTAINER BILL LOC OHIP CML Refer to CULTURE & SENSITIVITY, THROAT STREPTOCOCCUS THROAT SCREEN STREPTOLYSIN O ANTIBODY SPECIMEN REQUIREMENT 659 Serum Centrifuge only GOLD SST (ASOT) TAT – 1 day STREPTOZYME TEST Refer to STREPTOLYSIN O ANTIBODY SUCROSE LYSIS NO LONGER AVAILABLE SULFHEMOGLOBIN NO LONGER AVAILABLE SULPHONAMIDE NO LONGER AVAILABLE SURGICAL PATHOLOGY Refer to HISTOPATHOLOGY _________________________________________________________________________________________________________ Refer to TRIMIPRAMINE SURMONTIL (TRIMIPRAMINE) Refer to FLUID, TOTAL EXAM SYNOVIAL FLUID (FLUID, TOTAL EXAM) SYPHILIS (VDRL) (VDRL ROUTINE) (TPI – TREPONEMAL PALLIDUM INVESTIGATION) (FTA – TREPONEMAL ANTIBODIES) 9000 Do not centrifuge tube PLAIN RED Syphilis requests can be for Screen, Confirmatory or Diagnostic purposes ▀ Code S17 on PHL Form ▀ Reactive Syphilis screen test EIA is automatically tested by confirmatory procedures and RPR ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days TEST SPECIFICATION GUIDE – SECTION S Page 5 of 5 CML HealthCare Inc Test Specification Guide 18396 Version: 3.0 20-Feb-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. N/C PHL TEST NAME CODE T CELL LYMPHOCYTE MARKER ONLY SPECIMEN REQUIREMENT VACUTAINER BILL LOC Refer to LYMPHOCYTE MARKER – T CELLS ONLY (CD3, CD4, CD8) (LYMPHOCYTE MARKER- T CELLS ONLY) T3 RIA Refer to TRIIODOTHYRONINE, TOTAL T4 TOTAL, THYROXINE NO LONGER AVAILABLE (TOTAL T3) (TRIIODOTHYRONINE) TACROLIMUS 9720 (FK–506) (PROGRAF) Blood LAVENDER OHIP HLRC OHIP SKH STORE AND TRANSPORT AT ROOM TEMPERATURE Collect specimen Monday to Thursday only Send the specimen and a copy of the OHIP requisition in a Priority labelled ziplock bag. Transplant hospital and Transplant physician MUST be provided on the requisition or print “non-transplant” if indicated. TAT– variable TAY SACHS 99999 Blood (BETA n-ACETYLHEXOSAMINIDASE) 1 LAVENDER 1 PLAIN RED 1 GREEN - with Heparin Collect specimen Monday to Wednesday only STORE AND SEND AT ROOM TEMPERATURE Physician must complete a SKH Tay Sachs Registration Form and a Molecular Genetics Form The forms are available from the CML Problem solving Department Send the specimens and the forms in a Priority labelled ziplock bag Address Priority label: Hospital for Sick Kids Biochemical Genetics Laboratory 555 University Ave, Toronto M5G 1X8 TAT - 15 days T.B. CULTURE Refer to MYCOBACTERIA TUBERCULOSIS DETECTION (ACID FAST BACILLUS) (AFB) (TUBERCULOSIS CULTURE) T & B CELLS Refer to LYMPHOCYTE MARKERS, T & B CELLS (ACUTE LEUKEMIA PHENOTYPING) (LYMPHOPROLIFERATIVE DISEASE PHENOTYPING) TEST SPECIFICATION GUIDE – SECTION T Page 1 of 9 CML HealthCare Inc Test Specification Guide 17535 Version: 10.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE TBG SPECIMEN REQUIREMENT VACUTAINER BILL LOC Refer to THYROXINE BINDING GLOBULIN (THYROXINE BINDING GLOBULIN) TBII Refer to THYROID RECEPTOR ANTIBODIES (LATS) (LONG ACTING THYROID STIMULATOR) (THYROTROPIN BINDING INHIBITING IMMUNOGLOBULIN) (THYROID RECEPTOR ANTIBODIES) (TRAB) TSH RECEPTOR ANTIBODY TEGRETOL Refer to CARBAMAZEPINE (CARBAMAZEPINE) TELOPEPTIDE - N TESTOSTERONE, BIO AVAILABLE NO LONGER AVAILABLE – Refer to C-TELOPEPTIDE 9234 (BIO AVAILABLE TESTOSTERONE) Serum Minimum Volume required: 2 mL Centrifuge and aliquot to transfer tube. Store and ship refrigerated. GOLD SST $60.00 HLRC Test includes: Total Testosterone, Sex Hormone Binding Globulin, Albumin, and Calculated Bioavailable Testosterone Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT– 10 days TESTOSTERONE, FREE 608 Serum Centrifuge only GOLD SST OHIP CML GOLD SST OHIP CML State age and sex of patient TAT – 4 days TESTOSTERONE, TOTAL 340 (TESTICULAR ANDROGEN) Serum Centrifuge only State age and sex of patient TAT – 1 day TETANUS SEROLOGY TESTING NO LONGER AVAILABLE (CLOSTRIDIUM TETANI ANTIBODY) THALASSEMIA (ALPHA THALASSEMIA) (BETA THALASSEMIA) 9200 Whole Blood- 3 tubes LAVENDER N/C Min sample required – 10ml INCLUDES: CBC, Hemoglobin Electrophoresis and Ferritin DNA Genetic Testing Form must be completed at Dr’s office Prepackage sample with completed DNA form in PRIORITY envelope, addressed to HLRC/MUMC Collect Mon-Wed ONLY TAT – 8 weeks TEST SPECIFICATION GUIDE – SECTION T Page 2 of 9 CML HealthCare Inc Test Specification Guide 17535 Version: 10.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. HLRC TEST NAME CODE THC SPECIMEN REQUIREMENT VACUTAINER BILL LOC OHIP CML LAVENDER $70.00 HLRC PLAIN RED OHIP HLRC LAVENDER $150.00 GOLD SST OHIP HLRC LIGHT BLUE OHIP HLRC Refer to CANNABINOIDS SCREEN (CANNABIS) (CANNABINOIDS SCREEN) (MARIJUANA) (TETRAHYDROCANNABINOIDS) THEOPHYLLINE 321 (AMINOPHYLLINE) (UNIPHYL) Serum PLAIN RED Minimum specimen required: 2 mL Collect trough specimen 10 – 12 hours after the last dose Record time in hours that have elapsed between last dose and specimen collection. TAT – 1 day THIAMINE 9231 (VITAMIN B1) Plasma Minimum Volume required: 2 mL Centrifuge within 1 hour of collection Transfer plasma to amber transport tube FREEZE PLASMA AND SEND FROZEN TAT – 25 days THIOCYANATE 9947 Serum Minimum Volume required: 3 mL TAT – 10 days THIOPURINE S – METHLTRANSFERASE (TPMT) GENOTYPE 9311 (TPMT) Whole Blood Must complete form for molecular Hematology testing and submit with Specimen and requisition HLRC TAT – 13 days THIORIDAZINE 9731 (MELLARIL) Serum Centrifuge only TAT – 20 days THROMBOCYTE COUNT Refer to COMPLETE BLOOD COUNT (PLATELET COUNT) THROMBIN TIME 9743 (THROMBIN CLOTTING TIME) (COAGULATION THROMBIN INDUCED) Plasma Minimum Volume required: 1 mL Must be a clean venipuncture puncture Remove tourniquet when blood starts to flow FREEZE PLASMA AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 30 days TEST SPECIFICATION GUIDE – SECTION T Page 3 of 9 CML HealthCare Inc Test Specification Guide 17535 Version: 10.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE THROMBOPLASTIN TIME, PARTIAL SPECIMEN REQUIREMENT VACUTAINER BILL LOC OHIP CML GOLD SST $1000.00 HLRC GOLD SST OHIP CML GOLD SST OHIP HLRC GOLD SST $90.00 HLRC GOLD SST OHIP CML Refer to PARTIAL THROMBOPLASTIN TIME (PTT) THYROGLOBULIN 9494 Serum Centrifuge only GOLD SST Note: Not the same test as Thyroglobulin Antibody (HP16) TAT – 10 days THYROGLOBULIN ANTIBODY, 9571 QUANTITATIVE Serum Centrifuge and aliquot (TgAb QUANT) (QUANTITATIVE THYROGLOBULIN ANTIBODY) Store and ship refrigerated This test is not available for CCC use. This test is only for use at Kennedy Road for hospital patients TAT – 8 days THYROID MICROSOMAL ANTIBODIES HP16 (ATA) (ANTI-THYROID ANTIBODY) (MICROSOMAL ANTIBODIES) (MICROSOMAL THYROID ANTIBODIES) (THYROID ANTIBODIES) (THYROGLOBULIN ANTIBODIES) Serum Centrifuge only Positive results may be delayed due to interpretation by consultant. Note: Not the same test as Thyroglobulin (9494) TAT –2 days THYROID PEROXIDASE ANTIBODY 9953 Serum Centrifuge only (TPO AB) TAT –25 days THYROID RECEPTOR ANTIBODIES 9454 (LATS) Serum Minimum volume required: 2 mL Separate within 1 hour of collection (LONG ACTING THYROID STIMULATOR) FREEZE SERUM AND SEND FROZEN (TBII) (THYROPIN BINDING INHIBITOR Requires clinical information: thyroid status, Presence of exophthalmos IMMUNOGLOBULIN) (TRAB) TSH RECEPTOR ANTIBODY TAT – 30 days THYROTROPIN (SENSITIVE TSH) (TSH) 341 Serum Centrifuge only TAT – 1 day 3 MICROTAINERS ARE REQUIRED WHEN COLLECTING FROM AN INFANT TEST SPECIFICATION GUIDE – SECTION T Page 4 of 9 CML HealthCare Inc Test Specification Guide 17535 Version: 10.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE SPECIMEN REQUIREMENT THYROTROPIN BINDING INHIBITOR IMMUNOGLOBULIN VACUTAINER BILL LOC Refer to THYROID RECEPTOR ANTIBODIES (TBII) (THYROID STIMULATING ANTIBODY) (LATS) (LONG ACTING THYROID STIMULATOR) TRAB) TSH RECEPTOR ANTIBODY THYROXINE BINDING GLOBULIN 342 Serum Centrifuge only Submit Monday to Wednesday only (TBG) GOLD SST OHIP HLRC GOLD SST OHIP CML GOLD SST $60.00 HLRC PLAIN RED OHIP HLRC $50.00 HLRC TAT – 25 days THYROXINE, FREE 339 Serum Centrifuge only (FREE T4) TAT – 1 day 3 MICROTAINERS ARE REQUIRED WHEN COLLECTING FROM AN INFANT THYROXINE, TOTAL (T4) NO LONGER AVAILABLE TIBC Refer to IRON (IRON) (IRON BINDING CAPACITY) (IRON SATURATION) (TIBC) (UIBC) (TOTAL IRON BINDING CAPACITY) (TRANSFERRIN SATURATION) TISSUE TRANSGULTAMINASE 9744 IgA ANTIBODY Serum Centrifuge only TAT – 20 days TOBRAMYCIN � � PEAK 304TP TROUGH 304TT Serum Minimum Volume required: 1 mL Collection of trough (pre) and peak (post)doses must be collected Collect blood prior to and I-hour following I.M. injection Record time in hours that have elapsed between doses. FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 5 to 10 days TOCOPHEROL (VITAMIN E) 9386 Serum Minimum Volume required: 2 mL Protect from light by transferring serum into an amber transport tube. GOLD SST FREEZE SERUM AND SEND FROZEN. Refer to General Information Page for Specimen Processing & Transport Guidelines. TAT – 30 days TEST SPECIFICATION GUIDE – SECTION T Page 5 of 9 CML HealthCare Inc Test Specification Guide 17535 Version: 10.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE TOFRANIL SPECIMEN REQUIREMENT VACUTAINER BILL LOC Refer to IMIPRAMINE (IMIPRAMINE) TOPIRAMATE 9745 (TOPOMAX) Serum Minimum Volume required: 1 mL PLAIN RED OHIP HLRC PLAIN RED N/C PHL N/C PHL OHIP DYN FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 20 days TORCH STUDIES 9061 Do not centrifuge tube ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM ● Testing Includes Toxoplasmosis, Rubella, Cytomegalovirus &Herpes Serologies ● TAT – 15 days TOTAL IRON BINDING CAPACITY Refer to IRON (IRON) (IRON BINDING CAPACITY) (IRON SATURATION) (TIBC) (UIBC) (TRANSFERRIN SATURATION) TOTAL T 3 Refer to TRIIODOTHYRONINE, TOTAL (T3 RIA) (TRIIODOTHYRONINE) TOXOPLASMA GONDII ANTIBODY 9025 Do not centrifuge tube PLAIN RED ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days TPO AB Refer to THYROID PEROXIDASE ANTIBODY (ANTI–THYROID PEROXIDASE) TRANSCOBALAMIN TRANSFERRIN NO LONGER AVAILABLE 554 Serum Centrifuge only Refrigerate during storage and transport GOLD SST TAT – 15 days TEST SPECIFICATION GUIDE – SECTION T Page 6 of 9 CML HealthCare Inc Test Specification Guide 17535 Version: 10.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE TRANSFERRIN SATURATION SPECIMEN REQUIREMENT VACUTAINER BILL LOC Refer to IRON (IRON) (IRON BINDING CAPACITY) (IRON SATURATION) (TIBC) (UIBC) (TOTAL IRON BINDING CAPACITY) TRANSGLUTAMINASE IgA TISSUE (TTG) TRAZODONE Refer to TISSUE TRANSGLUTAMINASE IgA ANTIBODY 9422 (DESYREL) Plasma Minimum Volume required: 3 mL GREEN - with Heparin OHIP HLRC N/C PHL Collect specimen 10– 12 hours after last dose Record time in hours that have elapsed between last dose and specimen collection. Separate as soon as possible TAT – 20 days TREPONEMAL ANTIBODIES Refer to SYPHILIS (FLUORESCENT ABSORPTION TEST) (FTA- TREPONEMAL ANTIBODIES) (SYPHILIS) TREPONEMA PALLIDUM IMMOBILIZATION Refer to SYPHILIS (TPI) (SYPHILIS) TRIAZOLAM (HALCION) TRICHINELLA ANTIBODY NO LONGER AVAILABLE 9055 Do not centrifuge tube PLAIN RED (TRICHINOSIS IMMOBILIZATION ANTIBODY) (TIA) ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 5 days TRICHOMONAS VAGINALIS Refer to CULTURE & SENSITIVITY, GENITAL (TRICH) (WET PREPARATION) TRICYCLIC & TETRACYCLIC ANTIDEPRESSANTS See SPECIFIC DRUG SPECIMEN REQUIREMENTS Specify – Amitriptyline, Clomipramine, Desipramine, Doxepin, Imipramine, Maprotiline, Nortriptyline, Protriptyline, Trimipramine TAT – Variable TEST SPECIFICATION GUIDE – SECTION T Page 7 of 9 CML HealthCare Inc Test Specification Guide 17535 Version: 10.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE TRIGLYCERIDE TRIIODOTHYRONINE, FREE SPECIMEN REQUIREMENT VACUTAINER BILL LOC Refer to LIPID ASSESSMENT, FASTING/LIPID ASSESSMENT, NON FASTING 607 (FREE T3) Serum Centrifuge only GOLD SST OHIP CML GOLD SST OHIP CML OHIP DYN TAT – 1 day TRIIODOTHYRONINE REVERSE TESTING NO LONGER AVAILABLE (REVERSE T3) TRIIODOTHYRONINE, TOTAL 336 (T3 RIA) (TOTAL T3) Serum Centrifuge only TAT – 1 day TRIIODOTHYRONINE, UPTAKE NO LONGER AVAILABLE (T3 UPTAKE) TRIMIPRAMINE 079T (SURMONTIL) Plasma GREEN Minimum Volume required: 2 mL - with Heparin Centrifuge and aliquot into serum tube Collect trough specimen 10– 12 hours after last dose Record time in hours that has elapsed between last dose and specimen collection. Refrigerate during storage and transport. TAT – 20 days TRIPLE MARKER TEST Refer to MATERNAL SCREEN (DOWNS SYNDROME SCREEN) (IPS- INTEGRATED PRENATAL SCREENING) (MSS) (FETAL MARKERS) (MATERNAL SCREEN) TRIPTIL Refer to PROTRIPTYLINE (PROTRIPTYLINE) TROPONIN I Advise Doctor That We Do Not Perform This Test Send Patient Back To The Physician’ Office If The Physician Is Not Available, Send Patient To Hospital. (Possible Heart Attack Patient) TRYPSIN NO LONGER AVAILABLE TEST SPECIFICATION GUIDE – SECTION T Page 8 of 9 CML HealthCare Inc Test Specification Guide 17535 Version: 10.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE TRYPTASE 9949 SPECIMEN REQUIREMENT VACUTAINER Serum GOLD SST $65.00 Minimum Volume required: 2 mL Collect 15 minutes to 3 hours post allergic reaction Separate into 2 x 1ml aliquots and freeze as soon as possible Elasticize aliquots together and send frozen to Pre-Analytical Dept. FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 25 days TSH, SENSITIVE Refer to THYROTROPIN (SENSITIVE TSH) (THYROTROPIN) TSH, RECEPTOR Ab Refer to THYROID RECEPTOR ANTIBODIES (TRAB) (LATS) (TBII) TTG Refer to TISSUE TRANSGLUTAMINASE IgA ANTIBODY TYLENOL Refer to ACETAMINOPHEN (ACETAMINOPHEN) TYPHUS MURINE ANTIBODY Refer to RICKETTSIA ANTIBODY (R.AKARI) (RICKETTSIA ANTIBODY) (RMSP) (ROCKY MOUNTAIN SPOTTED FEVER) TYROSINE BILL Refer to PHENYLALANINE TEST SPECIFICATION GUIDE – SECTION T Page 9 of 9 CML HealthCare Inc Test Specification Guide 17535 Version: 10.0 22-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. LOC HLRC TEST NAME CODE UIBC SPECIMEN REQUIREMENT VACUTAINER BILL LOC Refer to IRON (IRON) (IRON BINDING CAPACITY) (IRON SATURATION) (TIBC) (TOTAL IRON BINDING CAPACITY) (TRANSFERRIN SATURATION) _________________________________________________________________________________________________________ UNIPHYL Refer to THEOPHYLLINE (AMINOPHYLLINE) (THEOPHYLLINE) URATE 252 (URIC ACID) Serum Centrifuge only GOLD SST OHIP CML OHIP CML OHIP CML OHIP HLRC OHIP CML TAT – 1 day URATE 252U (URIC ACID) 24-Hour Urine 10 mL aliquot – submit in a white cap conical tube No preservative State total 24-hour volume on the OHIP Requisition, on the specimen container and in “Notes & Instructions” . Testing includes urine creatinine and total volume. Retain a duplicate 50 mL sample in the fridge until test is reported. TAT – 2 days UREA 251 (BLOOD UREA NITROGEN) (BUN) Serum Centrifuge only GOLD SST TAT – 1 day UREA 251U (BUN) 24-Hour Urine 50 mL aliquot – submit in a white cap 90 mL container No preservative State total 24-hour volume on the OHIP Requisition, on the specimen container and in “Notes & Instructions” . Retain a duplicate 50 mL sample in the fridge until test is reported. TAT – 15 days UREAPLASMA Refer to MYCOPLASMA ISOLATION (MYCOPLASMA ISOLATION) URIC ACID Refer to URATE (URATE) URIC ACID, URINE (URATE RANDOM URINE) 252RU Urine 10 mL random urine Submit in a white cap conical tube TAT – 2 days TEST SPECIFICATION GUIDE – SECTION U Page 1 of 2 CML HealthCare Inc Test Specification Guide 18085 Version: 2.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME URINALYSIS, CHEMICAL CODE 5050 (URINALYSIS ROUTINE) SPECIMEN REQUIREMENT VACUTAINER Urine 10 mL random urine BILL LOC OHIP CML OHIP CML OHIP CML Submit in a YELLOW cap conical tube Test includes: Appearance, Colour, pH, Protein, Glucose, Keytone, Blood, Nitrite, Leukocyte Esterase and Specific Gravity TAT – 1 day URINALYSIS, MICROSCOPIC 5000 (URINALYSIS MICRO) Urine 10 mL random urine Submit in a RED cap conical tube Note: chemical urinalysis can be performed on the same Specimen submitted for urinalysis microscopic. TAT – 1 day URINE TOXICOLOGY Refer to DRUGS OF ABUSE SCREEN (DRUGS OF ABUSE) (DRUG SCREEN) (NARCOTIC SCREEN) (STREET DRUGS) UROBILINOGEN 254– 8 Urine 10 mL random urine Protect from light by transferring urine into an amber transport tube. TAT – 1 day UROBILINOGEN Stool - NO LONGER AVAILABLE UROPORPHYRIN Refer to PORPHYRINS, QUANTITATIVE (COPROPORPHYRINS) (PORPHYRINS) TEST SPECIFICATION GUIDE – SECTION U Page 2 of 2 CML HealthCare Inc Test Specification Guide 18085 Version: 2.0 2-Apr-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE VALPROATE 257 (DEPAKENE) (DIVALPROEX) (EPIVAL) (VALPROIC ACID) SPECIMEN REQUIREMENT VACUTAINER Serum PLAIN RED Minimum Volume required: 1 mL Collect trough specimen 10 – 12 hours after last dose BILL LOC OHIP CML OHIP HLRC OHIP HLRC Record time in hours that have elapsed between last dose and specimen collection. TAT – 1 day VALIUM Refer to DIAZEPAM (DIAZEPAM) VANCOMYCIN, PEAK 9105 Serum PLAIN RED Minimum Volume required: 1 mL Indicate peak specimen (post) Collect the peak specimen one hour following an IM injection, or 15 minutes following a 60 minute IV infusion, or 30 minutes following a 30 minute IV administration. State the time the IM or IV was administered and the time the specimen was drawn. FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 5 to 10 days VANCOMYCIN, TROUGH 9106 Serum Minimum Volume required: 1 mL Indicate trough specimen (pre) Collect the trough specimen immediately before the IM injection or IV infusion. PLAIN RED State the time the specimen was drawn and the time the IM or IV was administered. FREEZE SERUM AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines. TAT – 5 to 10 days TEST SPECIFICATION GUIDE – SECTION V Page 1 of 5 CML HealthCare Inc Test Specification Guide 18211 Version: 4.0 7-Jan-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME VANILLYMANDELATE CODE 261 (VMA) SPECIMEN REQUIREMENT VACUTAINER BILL LOC 24-Hour Urine OHIP 10 mL aliquot – submit in a white cap conical tube labelled “CREATININE” and a 50 mL aliquot –submit in a 90 mL white cap container labelled “VMA” Do NOT add acid; pH will be adjusted in Biochemistry Dept. CML Abstain from coffee, tea, cola, fruits, chocolate & vanilla 48 hours before and during collection. Note: Report may be delayed for confirmation of abnormal results. State total 24-hour volume on the OHIP Requisition, on the specimen container, and in “Notes & Instructions”. Testing includes urine creatinine and total volume. Retain a duplicate 50 mL sample in the fridge until test is reported. TAT – 14 days VARICELLA ZOSTER VIRUS ANTIBODY 9062 Do not centrifuge tube PLAIN RED N/C PHL PLAIN RED N/C PHL $75.00 HLRC Public Health Laboratory recommends both acute and convalescent specimens taken two weeks apart. (CHICKEN POX) (HERPES ZOSTER) (VARICELLA ANTIBODY) (ZOSTER ANTIBODY) (SHINGLES) ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days VACCINIA VIRUS ANTIBODY 9051 Do not centrifuge tube ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days VASOPRESSIN (ADH) (ANTIDIURETIC HORMONE) 9903 Plasma Collect in pre-chilled tube Minimum volume required: 3 mL LAVENDER FREEZE PLASMA AND SEND FROZEN TAT – 45 – 60 days VDRL Refer to SYPHILIS (SYPHILIS) (VDRL ROUTINE) TEST SPECIFICATION GUIDE – SECTION V Page 2 of 5 CML HealthCare Inc Test Specification Guide 18211 Version: 4.0 7-Jan-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME VERY LOW DENSITY LIPOPROTEIN CODE 9747 (VLDL) (ULTRACENTRIFUGATION HDL/LDL) SPECIMEN REQUIREMENT VACUTAINER Serum 3 GOLD SST Minimum Volume required: 7 mL Must be centrifuged within 6 hours of collection Alliquote serum into an empty red top vacutainer BILL LOC OHIP SMH N/C PHL N/C PHL N/C PHL OHIP HLRC (CHOLESTEROL IN VLDL) ● Testing Includes Cholesterol, Triglycerides, HDL/LDL ● TAT – 15 days VINCENT'S ORGANISMS Refer to GRAM STAIN VIRAL LOAD Refer to HIV VIRAL LOAD (HIV VIRAL LOAD) VIRAL STUDIES 9005 Do not centrifuge tube PLAIN RED Virus History Form must be completed If the virus is requested by name, this must be recorded on the Form. Public Health Laboratory recommends both acute and convalescent specimens taken two weeks apart. ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days VIRAL STUDIES 9049 Stool 5 g. (Approx. 1 teaspoon) random stool DO NOT USE CARY– BLAIR MEDIA Submit in VIRUS– TM media kit ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 10 days VIRAL STUDIES 637C (VIRUS ISOLATION) Swab – State source Submit in VIRUS– SW media kit ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 25 days VISCOSITY, RELATIVE QUANTITATIVE 9746 Whole blood 4 mL LAVENDER Do NOT centrifuge Store and transport at room temperature Submit Monday, Tuesday, Wednesday ONLY TAT – 15 days TEST SPECIFICATION GUIDE – SECTION V Page 3 of 5 CML HealthCare Inc Test Specification Guide 18211 Version: 4.0 7-Jan-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE VITAMIN A SPECIMEN REQUIREMENT VACUTAINER BILL LOC Refer to RETINOL (RETINOL) VITAMIN B1 Refer to THIAMINE VITAMIN B6 Refer to PYRIDOXINE VITAMIN B12 Refer to COBALAMINS VITAMIN C Refer to ASCORBATE (THIAMINE) (PYRIDOXAL PHOSPHATE) (PYRIDOXINE) (B12) (COBALAMINS) (ASCORBIC ACID) (ASCORBATE) VITAMIN D Refer to CALCITRIOL (1,25– DIHYDROXY VITAMIN D) (CALCITRIOL) VITAMIN D (UNINSURED) Refer to CALCIDIOL (UNINSURED) (25– HYDROXYVITAMIN D) (CALCIDIOL) VITAMIN D (INSURED) Refer to CALCIDIOL (INSURED) (25– HYDROXYVITAMIN D) (CALCIDIOL) VITAMIN E Refer to TOCOPHEROL (TOCOPHEROL) VLDL Refer to VERY LOW DENSITY LIPOPROTEIN (VERY LOW DENSITY LIPOPROTEIN) (ULTRACENTRIFUGATION HDL/LDL) VMA Refer to VANILLYMANDELATE (VANILLYMANDELIC ACID) VON WILLEBRAND FACTOR ACTIVITY 9983 Plasma Minimum Volume required: 2ml 1 LIGHT BLUE $60.00 HLRC 1 LIGHT BLUE $60.00 HLRC FREEZE PLASMA AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines TAT – 10 Days VON WILLEBRAND FACTOR ANTIGEN 9982 Plasma Minimum Volume required: 2ml FREEZE PLASMA AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines TAT – 17 Days VON WILLEBRAND FACTOR COFACTOR NO LONGER AVAILBLE TEST SPECIFICATION GUIDE – SECTION V Page 4 of 5 CML HealthCare Inc Test Specification Guide 18211 Version: 4.0 7-Jan-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME CODE VON WILLEBRAND FACTOR MULTIMERS VON WILLEBRAND FACTOR SCREEN (INCLUDES MULTIMERS) SPECIMEN REQUIREMENT VACUTAINER BILL LOC Refer to VON WILLEBRAND FACTOR SCREEN 9980 Plasma 2 LIGHT BLUE Minimum Volume required: 4 aliquots of 1ml Keep together with elastic band. Label all samples. $140.00 HLRC FREEZE PLASMA AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines Screening includes the following or the tests may be ordered separately: 9950 9982 9983 Von Willebrand Factor VIII-C Von Willebrand Factor Antigen Von Willebrand Activity Von Willebrand Multimers – Not offered as individual test $ 60.00 $ 60.00 $ 60.00 TAT – 20 days VON WILLEBRAND FACTOR VIII-C 9950 Plasma Minimum Volume required: 2ml 1 LIGHT BLUE FREEZE PLASMA AND SEND FROZEN Refer to the General Information Page for Specimen Processing & Transport Guidelines TAT – 10 Days TEST SPECIFICATION GUIDE – SECTION V Page 5 of 5 CML HealthCare Inc Test Specification Guide 18211 Version: 4.0 7-Jan-2014 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. $60.00 HLRC TEST NAME WARFARIN CODE SPECIMEN REQUIREMENT 9201 Plasma Minimum Volume required: 3 mL (COUMADIN) VACUTAINER BILL LOC GREEN - with Heparin $45.00 HLRC PLAIN RED N/C PHL TAT – 15 days Refer to COMPLETE BLOOD COUNT WBC (LEUKOCYTE COUNT) (WHITE BLOOD CELL COUNT) WEIL'S DISEASE Refer to LEPTOSPIRA ANTIBODY (LEPTOSPIRA ANTIBODY) (LEPTOSPIROSIS ANTIBODIES) WEST NILE VIRUS SEROLOGY 9911 Do not centrifuge tube State the patient’s clinical history on the PHL form and indicate acute or convalescent specimen ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 20 days WET PREPARATION Refer to CULTURE & SENSITIVITY, GENITAL (TRICH) (TRICHOMONAS VAGINALIS) WHITE BLOOD CELL COUNT Refer to COMPLETE BLOOD COUNT (LEUKOCYTE COUNT) (WBC) WHOOPING COUGH SEROLOGY NO LONGER AVAILABLE (BORDETELLA PERTUSSIS ANTIBODY) WHOOPING COUGH Refer to BORDETELLA PERTUSSIS WOOD LAMPS TEST Refer to DERMATOPHYTOSIS (DERMATOPHYTOSIS) (RINGWORM OF SCALP) TEST SPECIFICATION GUIDE – SECTION W Page 1 of 2 CML HealthCare Inc. Test Specification Guide 16918 Version: 1.3 3/25/2009 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME WORM IDENTIFICATION CODE 9090 SPECIMEN REQUIREMENT VACUTAINER Stool Submit whole specimen without contamination from other fluids BILL LOC N/C PHL N/C PHL ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days WORM IDENTIFICATION 9091 Worm Submit whole worm without contamination from other fluids ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days TEST SPECIFICATION GUIDE – SECTION W Page 2 of 2 CML HealthCare Inc. Test Specification Guide 16918 Version: 1.3 3/25/2009 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. TEST NAME XYLOSE ABSORPTION CODE 265 SPECIMEN REQUIREMENT Blood VACUTAINER GRAY (XYLOSE TOLERANCE) Adult test: Greater than 18 years of Age Must fast 8-hours before test Drink 25g Xylose dissolved in 250 mL of water followed by another 250 mL of water Collect blood 2-hours after consumption of drink Enter height and weight in �Notes & Instructions’. Child test: 12 – 18 years Must fast 8-hours before test Administer 25 g Xylose dissolved in 250 mL water followed by another 250 mL water. Collect blood 1 hour after consumption of drink. Child test: 12 years old and younger Chlidren 9-12 years old must fast overnight (at least 8 hours) Children younger than 9 years must fast 4-hours before test Must Drink 5g Xylose dissolved in 50 mL of water followed by another 250 mL of water Collect blood 1 hour after consumption of drink. TEST SPECIFICATION GUIDE – SECTION X Page 1 of 1 CML HealthCare Inc Test Specification Guide 14728 Version: 1.1 7/24/2008 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. BILL LOC OHIP DYN TEST NAME YERSINIA ANTIBODIES CODE 9073 SPECIMEN REQUIREMENT VACUTAINER BILL Do not centrifuge tube PLAIN RED N/C ▀ REQUESTING PHYSICIAN MUST PROVIDE COMPLETED PHL FORM TAT – 15 days TEST SPECIFICATION GUIDE – SECTION Y Page 1 of 1 CML HealthCare Inc Test Specification Guide 14729 Version: 1.1 7/24/2008 This document hardcopy must be used for reference only. The electronic copy must be used as the current version. LOC PHL TEST NAME CODE SPECIMEN REQUIREMENT VACUTAINER BILL LOC ROYAL BLUE - no additive OHIP HLRC OHIP DYN $60.00 HLRC Refer to ETHOSUXIMIDE ZARONTIN (ETHOSUXIMIDE) ZINC 266 Serum Minimum Volume required: 2 mL Centrifuge Aliquot into an empty plastic transfer tube Refrigerate during storage and transport. TAT – 15 days ZINC 266U 24-Hour Urine 50 mL aliquot – submit in a 90 mL white cap container Refrigerate during storage and transport. State total 24-hour volume on the OHIP Requisition on the specimen container and in “Notes & Instructions”. TAT – 15 days ZINC PROTOPORPHYRIN 9143 Whole Blood Do not centrifuge Collect Monday to Thursday only LAVENDER ▀ REQUESTING PHYSICIAN MUST COMPLETE FORM AVAILABLE FROM PROBLEM SOLVING DEPT. TAT – 15 days ZOLOFT Refer to SERTRALINE (SERTRALINE) ZYPREXA Refer to OLANZAPINE (OLANZAPINE) TEST SPECIFICATION GUIDE – SECTION Z Page 1 of 1 CML HealthCare Inc Test Specification Guide 17955 Version: 1.5 8/19/2011 This document hardcopy must be used for reference only. The electronic copy must be used as the current version.
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