LAB ORDER

LAB ORDERS make duplicate 2011 order(1).pdf

 

 

 

 

 

LAB ID  2ALNI/04610

         THE SKIN CENTER LAB ORDER  (REVISED 11/1/11) SEND EXTRA COPY TO DR : 
THE SKIN CENTER          LAB WEST/ LABCORP MEDICAL LABORATORIES      
Alai, Nili N.  M.D.           
26081 Merit Circle #109 STANDING ORDER    
Laguna Hills, CA 92653 Expires  6months from date
Telephone 949-582-7699/   FAX 949- 582-7691   
QUEST ID: 92653106-9         **TESTS  ARE NON-FASTING & ROUTINE  UNLESS MARKED OTHERWISE    □ FASTING
1.  ALOPECIA   704.1     2.  ACNE  /  HIRSUITISM     3. AUTOIMMUNE/ LUPUS     4.PRURITIS    
A.  Malaise/ Fatigue 780.79 A.Hypertrichosis 704.1   A.  Dermatitis 692.9   A. Pruritis 698.9  
B. Dermatitis 692.9   B. Malaise 780.79   B. Malaise/ Fatigue 780.79   B.  Malaise/ Fatigue 780.79
CMP(COMP METABOLIC) 80053 S C. Acne 706.1   C. Pain     C. Dermatitis 692.9  
CBC, DIFF, &  PLTS 82025  L CMP 82150              
SED RATE 85651 2L CBC, DIIF, & PLTS 85025 L URINALYSIS 81003(1) UR CMP 80053 S
RPR- ROUTINE 86592 S SED RATE 85651 2L ANA (EIA) 86039 S CBC, DIFF, &  PLTS 85025  L
ANA (EIA) 86039 S Free testosterone   DS-DNA     SED RATE 85651 2L
FERRITIN 82728 S Sex hormone binding globulin RNP-SM     ANA (EIA) 86039 S
FOLATE 82746 S DHEA-S   ANTI-RO (SSA)     FERRITIN 82728 S
IRON 83540 S Androstenedione   ANTI-LA (SSB)     FOLATE 82746 S
T4 84436 S 3-Androstanediol Glucoronide SCL-70     IRON 83540 S
TSH  84443 S TSH   HISTONE     TSH (3RD GEN) 84443 S
VIT B12 82607 S Free T4   C3, C4, TOTAL COMPLEM   VIT B12 82607 S
■ Free testosterone   Level Two (FASTING) TPO ANTIBODY   H. PYLORI AB IgG & IgM
■ Thyroglobulin Auto Abs Prolactin   RHEUMATOID FACTOR (RF) IgE  
■ Thyroid peroxidase (TPO) FSH, LH   ANTI CARDIOLIPIN ABS   ANTITHYROID AB  
■  DHEA-S    Fasting glucose   ANTI-SMITH ABS   HEP B, C SCREEN  
■25- Hydroxy Vitamin D   Fasting insulin   ANTI-MITOCHOND ANTIBODY TPO  
*If ANA+, please run full Lupus Panel  17 alpha-OH progesterone   *If ANA+, please run full Lupus Panel
including C3, C4, RF DS-DNA Lipid profile         including C3, C4, RF DS-DNA
anti-SM, anti-RO, anti-LA, etc 25- Hydroxy Vitamin D           anti-SM, anti-RO, anti-LA, etc
5. URTICARIA 708.9,Dermatitis 692.9   , Malaise/ Fatigue (780.79) 6.  VITILIGO 692.9, 780.79 malaise 7.  ONYCHOMYCHOSIS 101.1
                         DX Pain 780.96
H.Pylori AB Hep A, B, C screen Anti-TPO antibody   CMP 80053 S
CMP 80053 S TPO ANTIBODY Thyroid peroxidase Antibody CBC, DIFF, &  PLTS 85025 25L
CBC, DIFF, &  PLTS 85025 L thyroglobulin auto abs CMP 80053 S STANDING ORDER REPEAT 
SED RATE 85651 2L STOOL O&P & C&S CBC, DIFF, &  PLTS 85025 L MONTHLY X 4 MOS  
ANA (EIA) 86039 S SED RATE 85651 2L EXPIRES DATE:  in 6 Months
T4 84436 S **If ANA+, please run full Lupus Panel  ANA (EIA) 86039 S (6 mos from today’s date)
TSH  84443 S including C3, C4, RF DS-DNA FERRITIN 82728 S And repeat every 4 wks 
IgM + IgG + IgE   anti-SM, anti-RO, anti-LA, etc FOLATE 82746 S while on Lamisil/Sporonox
IRON 83540 S 8. GENERAL CHECKUP
TAKE TO ANY LAB:  LOOK UP  LOCATIONS ON LINE    T4 84436 S CMP 80053 S
1. LAB CORP  949-586-6590 www.labcorp.com   TSH (3RD GEN) 84443 S CBC, DIFF, &  PLTS 85025  L
2. QUEST DIAGNOSTICS   (949) 380-9980   www.questdiagnostics.com VIT B12 82607 S Fasting Lipid profile ( Cholest, Triglyc)
PLEASE ASK LAB TO FAX  RESULTS TO THE SKIN CENTER   25- Hydroxy Vitamin D
  9. Propecia every 6-12 months
RADIOLOGY ORDER: ORANGE COAST IMAGING   CALL   949-462-3999   FAX 949-462-3777       CBC, DIFF, & PLTS; COMP METABOLIC
1. XRAY of   Chest – 2 views  PA and Lat   DX cough           PSA  
2. CT SCAN   CHEST   ABD PELVIS   with and without contrast  DX: PAIN, NEOPLASM        
3. Ultrasound Pelvic-    DX  cystic ovaries, PCOS   10. ROUTINE AEROBIC CULTURE
4. MRI C- Spine   Dx: Neck pain,  Disc disease   CULTURE & SENSITIVITY ( C&S)
5. Ultrasound Legs- Veins, dx clot    SEE TUBE FOR COLLECTION TIME
6. Mammography:   Screening unless marked otheriwse      □ Diagnostic- lump  breast     SOURCE:  SKIN ** see tube
       
PATIENT’S NAME:   MD SIGNATURE:  DX:  692.9 dermatitis  
      REQUIRES SIGNATURE***** DX:  695.9folliculitis   
DATE OF BIRTH:     DX: 704.8