EV MED Research Enterovirus VP1 Immunoperoxidase stain Test
Request Form (Dr. Chia)
EV MED RESEARCH
25332 Narbonne Ave, Suite 170, Lomita, Ca. 90717
Tel: 310 534 9700
Fax: 310 534 9701
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Patient Name: ________________________________________
DOB:_________________
Address:
___________________________________________________________________
City:_______________________________________
State:__________
Zip:___________ Phone: _______________________
Fax:_____________________
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Male
□
Female
Email address: __________________________________________
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Enterovirus
VP1 Immunoperoxidase
stain
CPT Code:
88342*
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Clinical
Application
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Specificity
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The qualitative immunoperoxidase is used to detect the presence of enteroviral protein within the stomach
biopsies or other tissue sections.
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Detects most of the human enteroviruses, including coxsackie A and B,
echoviruses, and enteroviruses 68-71. The antibody used in this assay is
specific for enteroviruses, but does not differentiate between serotypes
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Specimens
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Shipping
Instructions
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the service of a
gastroenterologist is required to undergo an endoscopy and to obtain the
biopsy tissue. 2-3 biopsies should be done on inflamed areas of the
antrum, fixed in formalin
and paraffin-embedded for pathological examination. Have the pathologist
sent 5 unstained
slides containing the
paraffin-embedded tissue biopsy (4 micron thickness).
The tissues should be on
charged slides.
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You can request the pathologist to send the slides including the
pathology report to our address above.
You can send the requisition form and the payment separately to the
address above.
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Turnaround
Time
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Testing Fee
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1-2 week
upon arrival
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$250
(The
fee of this test does not include the endoscopy
procedure.)
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EV Med Research is a
fee-for-service provider and does not bill any insurance carriers.
I agree to pay the costs for the analyses
requested at the time of service.
The receipt for the analyses will be sent to me from EV Med Research.
If I choose, I can submit this receipt to my insurance carrier for
reimbursement.
Patient Signature_____________________________________ Date
________________
*
The CPT codes provided are based on EV MED’s interpretation of the
American Medical Association’s Current Procedural Terminology (CPT) codes and
are provided for informational purposes only.
CPT coding is the sole responsibility of the billing party.
Questions regarding coding should be addressed to your local Medicare
carrier. EV MED assumes no
responsibility for billing errors due to reliance on the CPT codes illustrated
in this material.
Some of the immunohistochemical stain(s) used for evaluation of this specimen
are analyte-specific reagents.
These tests were developed and their performance characteristics were determined
by EV Med Research Laboratory. They
have not been cleared or approved by the Food and Drug Administration.
The FDA has determined that such clearance or approval is not necessary.
The test is used for clinical purposes.
It should not be regarded as investigational or for research.
Dig Deeper! Check
out a Two Part Interview with Dr. Chia