Last Modified: 9/8/2021 6:42:41 AM

Medical Necessity Documentation:  
Client Notes:  
Patient Preparation:  
Specimen Requirements:

1.0 mL Serum from a Red Top Tube in a Plastic Vial

Collection Instructions: Promptly centrifuge and separate serum into a plastic screw-capped vial.
Minimum Volume: 0.4 mL Serum
Transport & Storage: Temperature/Stability:  
Rejection Criteria: Polymer gel separation tube (SST or PST).
Reference Range: Please refer to interpretive results
Critical Ranges:  
Test Comments: 14 days Ambient
14 days Refrigerated (transport)
2 months Frozen 
Methodology: High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS)
Clinical Significance: Therapeutic drug monitoring.
Custom Panel: No


Turn Around Time: 5 days
Days Performed: Monday, Tuesday, Wednesday, Thursday, Friday
Sites Performed: National Medical Services
PHL Test Code: MSOT
EPIC Test Code: MISC
Send Out Test Code: 1267SP
Alternate Test Names: Clabazam Alias Onfi ; Frisium®; Onfi®; Sympazan™; Urbanyl®
Included Tests:  
CPT Coding: 80339

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