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Custom Blood Panel Request
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Account Name
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Account Number
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Panel Name
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Sales Representative/Provider Signature
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EMR
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Apollo Web Portal
TOP IN-HOUSE TEST
Order Name and Code
ABORh Type | 424600
ABORh Type and Antibody Screen | 424605
Acute Hep Panel | 410045
ANA Screen | 424001
Apo B | 411160
B-hCG | 441110
BMP (Basic Metabolic Panel) | 410005
C3 | 411170
C4 | 411175
Cardiolipin Antibodies, IgG, IgM, and IgA | 411335
CBC | 420001
CBCw Diff | 420002
Chlamydia and Gonorrhea Panel-TMA (Urine) | 424310
CMP (Comprehensive Metabolic Panel) | 410010
Cortisol | 441120
CPK | 411180
CRP | 411190
CRP-HS 411195
Cyclic Citrullinated Peptide (CCP) Antibody, IgG | 424060
DHEA Sulfate, Serum | 424065
ESR Sedimentation Rate | 420170
Estradiol | 441020
Ferritin | 441125
Folate | 441100
Free T3 | 441055
Free T4 | 441060
FSH | 441040
GGT | 411220
Glucose | 411025
Order Name and Code
HBA1c | 412005
HCG Qualitative Serum | 411300
HCG Qualitative UR | 413051
Hemoglobin/Hematocit | 420003
Hepatic Function Panel (Liver Panel) | 410015
Hepatitis A IgM Antibody | 423025
Hepatitis B Surface Antibody | 423010
Hepatitis B Surface Antigen | 423030
Hepatitis C Antibody | 423005
HIV Ag/Ab | 423035
Homocysteine | 411230
HSV-1 Type Specific (Serum) | 411445
HSV 1 and 2 Type Specific IgG (Serum) | 411451
HSV-2 Type Specific IgG (Serum) | 411450
HSV Types 1 and 2 (NAAT) (SWAB) | 424080
IGF (Insulin-Like Growth Factor 1) | 411780
Insulin | 441105
Iron | 411205
Iron Study | 410040
Keppra (Levetiracetam) | 411755
Lipid Panel | 410025
Lipid Panel, Extended | 415195
Lithium | 411255
Luteinizing Hormone/ LH | 441070
Magnesium, Serum | 411145
Microalbumin urine | 413045
Microalbumin/Creatinine Ratio | 410050
Parathyroid Hormone, Intact/ IPTH | 441085
Phosphorous | 411140
Order Name and Code
Progesterone | 441030
Prolactin | 441130
PSA | 441090
PSA Total + % Free | 415205
QuantiFERON TB | 424350
RETIC | 420165
Rheumatoid Factor | 411285
Sex Hormone Binding Globulin | 441075
Syphilis | 423040
Syphilis w/ Reflex to RPR Titer and TP-PA Confirmation | 423041
T. Vaginalis NAAT | 424440
T3 Total/ Triiodothyronine | 441045
T3U | 441065
Testosterone, Free and Total (Includes Sex Hormone Blinding Globulin),Adult Male | 441018
Testosterone, Total | 441015
Thyroglobulin Ab | 441175
Thyroid Panel | 410035
Thyroperoxidase AB/ TPO Ab | 441185
Transferrin | 441145
TSH | 441035
TT4 | 441050
Uric Acid | 411080
Urinalysis, Complete w/Microscopic Exam | 471001
Vaginitis Panel | 424295
Valproic Acid | 411295
VIT B12 | 441005
Vitamin D, 1, 25-Dihydroxy | 417015
Vitamin D, 25-Hydroxy | 441010
TOP SEND-OUT TEST
Order Name and Code
Copper, Serum or Plasma | 460205
Estrogens, Fractionated by TMS | 460275
Estrone by TMS | 460290
HSV 1 and/or 2 Abs, IgM by ELISA | 460390
Lead, Blood (Venous) | 460475
Lyme Abs, IgG and IgM by Immunoblot | 460480
MMA Serum/Plasma, Vitamin B12 Status | 460515
Order Name and Code
Oxcarb or Eslicarb Metabolite (MHD) | 460540
Pregnenolone by LC-MS/MS, S or P | 466815
Protein Electrophoresis, Serum | 460550
Rocky Mountain Spotted Fever IgG and IgM | 460620
Testosterone, Free(Adult Females,Children, or Indiv on Testos-Supp Hormone Therapy) | 463265
Triiodothyronine,T3 Reverse by TMS | 460725
Order Name and Code
Vitamin A (Retinol), Serum or Plasma | 463435
Vitamin B1 (Thiamine), Plasma | 460780
Vitamin B1 (Thiamine), Whole Blood | 460785
Vitamin B3 (Niacin and Metabolites) Serum/Plasma | 46001687
Vitamin B6 (Pyridoxal 5-Phosphate) | 460790
Zinc, Serum or Plasma | 460795
ADDITONAL TEST
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