Spreadsheet: c03c87bc-1a23-49fe-a74c-5a817750c6e4
Sheet: Sheet1

Test Referenced | Entry Type | Mayo ID | Description | Reporting Description | Method | Collection Container | Temperature | Stability | [NAME] | Unit of Measure | [NAME] | Minimum Volume | Reject Due To | Reference Values | Days/Times Performed | Analytic Time | Maximum Lab Time | CPT Units | CPT Code | LOINC® Code | LOINC® Attributes | Always Performed | Orderable Separately | Performing Location
FXPB | Test | FXPB | Fragile X Syndrome, Molecular Analysis | Fragile X Syndrome, [NAME]. Analysis | Polymerase Chain Reaction (PCR)-Based Assays  (PCR is utilized pursuant to a license agreement with Roche Molecular Systems, Inc.) | Varies: Var |  |  |  | Varies | Forms: 1. New York Clients-Informed consent is required. Please document on the request form or electronic order that a copy is on file. An Informed Consent for Genetic Testing (Supply T576) is available in Special Instructions. 2. Molecular Genetics-Congenital Inherited Diseases Patient Information Sheet (Supply T521) in Special Instructions 3. If not ordering electronically, submit a Molecular Genetics Request Form (Supply T245) with the specimen.   [NAME] must arrive within 96 hours of collection.  	 Submit only 1 of the following specimens:   Specimen Type: Whole blood Container/Tube: Preferred: Lavender top (EDTA) or yellow top (ACD) Acceptable: Any anticoagulant [NAME]: 3 mL	 Collection Instructions:	 1. Invert several times to mix blood. 2. Send specimen in original tube.	 Specimen Stability Information: Ambient (preferred)/Refrigerated  		 Due to the complexity of prenatal testing, consultation with the laboratory is required for all prenatal testing. Prenatal specimens can be sent Monday through Thursday and must be received by 5 p.m. CST on Friday in order to be processed appropriately. All prenatal specimens must be accompanied by a maternal blood specimen. Order MCC / Maternal Cell Contamination, Molecular Analysis on the maternal specimen.  			 Specimen Type: Amniotic fluid Container/Tube: Amniotic fluid container [NAME]: 20 mL Specimen Stability Information: Refrigerated (preferred)/Ambient   Specimen Type: Chorionic villi Container/Tube: 15-mL tube containing 15 mL of transport media [NAME]: 20 mg Additional Information: FMR1-methylation status cannot be assessed on some chorionic villus specimens. Contact a genetic counselor/consultant at Mayo Medical Laboratories at [PHONE] or [PHONE] to discuss the limitations of testing prior to sending a chorionic villus specimen for fragile X analysis. Specimen Stability Information: Refrigerated   Acceptable: [NAME] Confluent cultured cells Container/Tube: T-25 flask [NAME]: 2 flasks Collection Instructions: Submit confluent cultured cells from another laboratory. Specimen Stability Information: Ambient (preferred)/Refrigerated | Blood: 0.5 mL/ Amniotic Fluid: 1 | Hemolysis	NA Thawing	NA Lipemia	NA Icterus	NA Other	NA | Normal alleles: 5-44 CGG repeats Intermediate (grey zone) alleles: 45-54 CGG repeats Premutation alleles: 55-200 CGG repeats Full mutation alleles: >200 CGG repeats An interpretive report will be provided. | Monday, Wednesday; 10 a.m. | 4 days | 10 days | 1 | 81243 |  |  |  |  | Rochester
FXPB | [NAME] | VARIES | Varies |  |  |  | See instructions
FXPB | Result | 16468 | [NAME] | [NAME] | Alphanumeric
FXPB | Result | 16469 | [NAME] | [NAME] | Alphanumeric
FXPB | Result | 16470 | Source | Source | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 31208-2 | [NAME] source:Prid:Pt:[NAME]:Nom:
FXPB | Result | 16471 | Order Date | Order Date | Alphanumeric
FXPB | Result | 16472 | Reason For Referral | Reason For Referral | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 42349-1 | Reason for referral:Find:Pt:^Patient:Nar:
FXPB | Result | 16473 | Method | Method | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 49549-9
FXPB | Result | 16474 | Result | Result | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 36913-2 | FMR1 gene mutation analysis:Prid:Pt:Bld/Tiss:Nar:Molgen
FXPB | Result | 16475 | Interpretation | Interpretation | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 69047-9 | Service comment 01:Imp:Pt:[NAME]:Nom:
FXPB | Result | 16476 | Amendment | Amendment | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 36913-2 | FMR1 gene mutation analysis:Prid:Pt:Bld/Tiss:Nar:Molgen
FXPB | Result | 16477 | Reviewed By: | Reviewed By: | Alphanumeric
FXPB | Result | 16478 | Release Date | Release Date | Alphanumeric
FXPB | [NAME] | FBC | Fibroblast Culture for Genetic Testing | Fibroblast Culture for Genetic Test | Cell Culture | Medium: Med |  |  | 30 | mg | Provide a reason for referral with each specimen. The laboratory will not reject testing if this information is not provided, but appropriate testing and interpretation may be compromised or delayed.  Forms: If not ordering electronically, submit a Cytogenetics/AFP Congenital Disorders Request Form (Supply T238) with the specimen.  Advise Express Mail or equivalent if not on courier service.   Submit only 1 of the following specimens:   Specimen Type: Autopsy Container/Tube: Sterile container with sterile Hank's balanced salt solution (Supply T132), [NAME]'s solution, or normal saline [NAME]: 4-mm diameter Collection Instructions: 1. Wash biopsy site with an antiseptic soap. 2. Thoroughly rinse area with sterile water. 3. Do not use alcohol or iodine preparations. 4. Biopsy specimens are best taken by [NAME] to include full thickness of dermis.   	 [NAME]: 15-mL tube containing 15 mL of transport media [NAME]: 20-30 mg Collection Instructions: 1. Collect specimen by the transabdominal or transcervical method. 2. Transfer the chorionic villi specimen to a Petri dish containing transport medium (Supply T095). 3. Using a stereomicroscope and sterile forceps, assess the quality and quantity of the villi and remove any blood clots and maternal decidua.    [NAME] of conception or stillbirth Container/Tube: Sterile container with sterile Hank's balanced salt solution (Supply T132), [NAME]'s solution, or normal saline [NAME]: 1 cm(3) of placenta (including 20 mg of chorionic villi) and a 1 cm(3) biopsy specimen of muscle/fascia from the thigh Collection Instructions: If a fetus cannot be specifically identified, collect 50 mg villus material or tissue that appears to be of fetal origin. Additional Information: Do not send entire fetus. Forms: Final Disposition of Fetal/Stillborn Remains form (if fetal specimen is sent) in Special Instructions.  	 [NAME]: Skin biopsy Container/Tube: Sterile container with sterile Hank's balanced salt solution (Supply T132), [NAME]'s solution, or normal saline [NAME]: 4-mm diameter Collection Instructions: 1. Wash biopsy site with an antiseptic soap. 2. Thoroughly rinse area with sterile water. 3. Do not use alcohol or iodine preparations. 4. A local anesthetic may be used. 5. Biopsy specimens are best taken by [NAME] to include full thickness of dermis. | [NAME]: 5 mg/Products o | Hemolysis	NA Thawing	NA Lipemia	NA Icterus	NA Other	NA | Not applicable | Samples processed Monday through Sunday. Results reported Monday through Friday, 8 a.m.-5 p.m. CST. | 41 days | 42 days |  | Profile |  |  | No | Yes
FBC | [NAME] | TISSUE | Tissue |  |  |  | Refrigerated
FBC | Order Question | CG030 | Source |  | Answer List
FBC | Option | CG030-1 | Autopsy
FBC | Option | CG030-2 | [NAME]
FBC | Option | CG030-3 | Products of Conception or Stillbirth
FBC | Order Question | CG033 | Reason for Referral |  | Plain Text
FBC | Result | 16167 | [NAME] | [NAME] | Alphanumeric
FBC | Result | 16337 | [NAME] | [NAME] | Alphanumeric
FBC | Result | CG030 | Source | Source | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 31208-2 | [NAME] source:Prid:Pt:[NAME]:Nom:
FBC | Result | 16168 | Order Date | Order Date | Alphanumeric
FBC | Result | CG033 | Reason For Referral | Reason For Referral | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 42349-1 | Reason for referral:Find:Pt:^Patient:Nar:
FBC | Result | 16172 | Method | Method | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 49549-9
FBC | Result | 16175 | Interpretation | Interpretation | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 69965-2
FBC | Result | 16176 | Amendment | Amendment | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | In Process
FBC | Result | 16177 | Consultant | Consultant | Alphanumeric
FBC | Result | 16178 | Report Date | Report Date | Alphanumeric
FXPB | [NAME] | AFC | Amniotic Fluid Culture for Genetic Testing | Amniotic Fluid Culture/Genetic Test | Cell Culture | [NAME], sterile container: SrwStlCont |  |  | 10 | mL | Provide a reason for referral and gestational age with each specimen. The laboratory will not reject testing if this information is not provided, but appropriate testing and interpretation may be compromised or delayed.   Optimal timing for specimen collection is during 14 to 18 weeks of gestation, but specimens collected at other weeks of gestation are also accepted.   Container/Tube: Amniotic fluid container [NAME]: 5-10 mL Collection Instructions:  1. Discard the first 2 mL of amniotic fluid. If the culture will be performed in conjunction with chromosome analysis and alpha-fetoprotein, a total of approximately 25 mL to 30 mL will be needed for the combined studies. 2. Place the tubes in a [NAME] container (Supply T329). 3. Fill remaining space with packing material. 4. Unavoidably, about 1% to 2% of mailed-in specimens are not viable. 5. Bloody specimens are undesirable. 6. If the specimen does not grow in culture, you will be notified within 7 days of receipt.  Additional Information:  1. Advise Express Mail or equivalent if not on courier service 2. Results will be reported and also telephoned or faxed, if requested. Forms: 1. New York Clients-Informed consent is required. Please document on the request form or electronic order that a copy is on file. An Informed Consent for Genetic Testing (Supply T576) is available in Special Instructions. 2. If not ordering electronically, submit a Cytogenetics/AFP Congenital Disorders Request Form (Supply T238) with the specimen. | 5 mL | Hemolysis	NA Thawing	NA Lipemia	NA Icterus	NA Other	NA | Not applicable | Samples processed Monday through Sunday. Results reported Monday through Friday, 8 a.m.-5 p.m. CST. | 23 days | 24 days |  | Profile |  |  | No | Yes
AFC | [NAME] | AMNIOTIC | Amniotic Fld |  |  |  | Ambient
AFC | Order Question | CG132 | Reason For Referral |  | Plain Text
AFC | Result | 16179 | [NAME] | [NAME] | Alphanumeric
AFC | Result | 16338 | [NAME] | [NAME] | Alphanumeric
AFC | Result | 16793 | Source | Source | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 31208-2 | [NAME] source:Prid:Pt:[NAME]:Nom:
AFC | Result | 16180 | Order Date | Order Date | Alphanumeric
AFC | Result | CG132 | Reason For Referral | Reason For Referral | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 42349-1 | Reason for referral:Find:Pt:^Patient:Nar:
AFC | Result | 16184 | Method | Method | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 49549-9
AFC | Result | 16187 | Interpretation | Interpretation | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 69965-2
AFC | Result | 16188 | Amendment | Amendment | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | In Process
AFC | Result | 16189 | Consultant | Consultant | Alphanumeric
AFC | Result | 16190 | Report Date | Report Date | Alphanumeric
FXPB | [NAME] | FXFU | Fragile X, Follow up Analysis | Fragile X, Follow Up Analysis | Southern Blot |  |  |  |  |  | This is not an orderable test.   Note: This follow-up test is added by the laboratory dependent upon on the result of the PCR analysis (FXPB / Fragile X Syndrome, Molecular Analysis). |  |  | Not applicable |  |  |  | 1 | 81244 |  |  | No | No
FXFU | Result | 33880 | [NAME] | [NAME] | Alphanumeric
FXFU | Result | 33881 | [NAME] | [NAME] | Alphanumeric
FXFU | Result | 33882 | Source | Source | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 31208-2 | [NAME] source:Prid:Pt:[NAME]:Nom:
FXFU | Result | 33883 | Order Date | Order Date | Alphanumeric
FXFU | Result | 33884 | Result | Result | Alphanumeric
FXFU | Result | 33885 | Amendment | Amendment | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | In Process
FXFU | Result | 33886 | Reviewed By | Reviewed By | Alphanumeric
FXFU | Result | 33887 | Released Date | Released Date | Alphanumeric
FXPB | [NAME] | MCC | Maternal Cell Contamination, Molecular Analysis | Maternal Cell Contamination, B | Polymerase Chain Reaction (PCR)-Based Comparison of Microsatellite Markers (PCR is utilized pursuant to a license agreement with Roche Molecular Systems, Inc.) | EDTA (lavender-top) tube: EDTA |  |  | 3 | mL | A maternal specimen and a prenatal specimen are required. MCC / Maternal Cell Contamination, Molecular Analysis must be ordered on both the prenatal and maternal specimens under separate order numbers.   Forms: New York Clients-Informed consent is required. Please document on the request form or electronic order that a copy is on file. An Informed Consent for Genetic Testing (Supply T576) is available in Special Instructions.   [NAME] must arrive within 96 hours of collection.   Specimen Type: Maternal blood Container/Tube: Preferred: Lavender top (EDTA) or yellow top (ACD) Acceptable: Any anticoagulant [NAME]: 3 mL	 Collection Instructions:	 1. Invert several times to mix blood. 2. Send specimen in original tube. Specimen Stability Information: Ambient (preferred)/Refrigerated   If a prenatal specimen has already been submitted as part of another diagnostic test, a second prenatal specimen is not required. If a prenatal specimen has not yet been submitted, submit only 1 of the following specimens:   Specimen Type: [NAME] blood Container/Tube: Preferred: Lavender top (EDTA) or yellow top (ACD) Acceptable: Any anticoagulant [NAME]: 3 mL	 Collection Instructions:	 1. Invert several times to mix blood. 2. Send specimen in original tube. Specimen Stability Information: Ambient (preferred)/Refrigerated   Specimen Type: Amniotic fluid Container/Tube: Amniotic fluid container [NAME]: 20 mL		 Specimen Stability Information: Refrigerated (preferred)/Ambient Additional Information: A separate culture charge will be assessed under AFC / Amniotic Fluid Culture for Genetic Testing.   Specimen Type: Cultured amniocytes Container/Tube: T-25 flask [NAME]: 2 full flasks Collection Instructions: Submit confluent cultured cells from another laboratory. Specimen Stability Information: Ambient (preferred)/Refrigerated   Specimen Type: Chorionic villi Container/Tube: 15-mL tube containing 15 mL of transport media [NAME]: 20 mg Specimen Stability Information: Refrigerated Additional Information: A separate culture charge will be assessed under FBC / Fibroblast Culture for Genetic Testing.   Specimen Type: Cultured chorionic villi Container/Tube: T-25 flasks [NAME]: 2 full flasks Collection Instructions: Submit confluent cultured cells from another laboratory. Specimen Stability Information: Ambient (preferred)/Refrigerated | Amniotic Fluid: 10 mL/Blood: 0.5 | Hemolysis	NA Thawing	Warm OK; Cold OK Lipemia	NA Icterus	NA Other	NA | An interpretative report will be provided. | Monday, Wednesday; 10 a.m. | 5 days | 11 days | 1 | 81265 |  |  | No | Yes
MCC | [NAME] | VARIES | Varies |  |  |  | See instructions
MCC | Result | 23332 | [NAME] | [NAME] | Alphanumeric
MCC | Result | 23333 | [NAME] | [NAME] | Alphanumeric
MCC | Result | 23334 | Source | Source | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 31208-2 | [NAME] source:Prid:Pt:[NAME]:Nom:
MCC | Result | 23335 | Order Date | Order Date | Alphanumeric
MCC | Result | 23338 | Result | Result | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 40704-9 | Maternal cell contamination:Prid:Pt:[NAME]:Nom:
MCC | Result | 23337 | Amendment | Amendment | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 40704-9 | Maternal cell contamination:Prid:Pt:[NAME]:Nom:
MCC | Result | 23341 | Reviewed By: | Reviewed By: | Alphanumeric
MCC | Result | 23339 | Release Date | Release Date | Alphanumeric