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Ship specimens to: Billing Information Mayo Clinic Laboratories • An itemized invoice will be sent each month. 3050 Superior Drive NW • Payment terms are net 30 days. Rochester, MN 55901 Call the Business Office with billing related questions: Customer Service: 855-516-8404 800-447-6424 (US and Canada) 507-266-5490 (outside the US) Visit www.MayoClinicLabs.com for the most up-to-date test and shipping information. T244 ©2021 Mayo Foundation for Medical Education and Research Page 1 of 5 MC0767rev0821 Patient Information (required) Patient ID (Medical Record No.) Client Account No.

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MOLECULAR DIAGNOSTICS DENGS Dengue Virus, Molecular Detection, CSFME Meningitis/Encephalitis Pathogen Panel, PCR, Serum PCR, Spinal Fluid LADV Adenovirus, Molecular Detection, PCR, Varies DENGC Dengue Virus, Molecular Detection, LCMSP Microsporidia species, PCR, Spinal Fluid Molecular Detection, PCR, Varies LCADP Adenovirus, Molecular Detection, PCR, Plasma EHRL Ehrlichia/Anaplasma, Molecular Detection, MTBRP Mycobacterium tuberculosis Complex, PCR, Blood Molecular Detection, PCR, Varies LBAB Babesia species, Molecular Detection, PCR, Blood ENTP Enterovirus, Molecular Detection, PCR, MTBXP Mycobacterium tuberculosis, Complex, Plasma Molecular Detection, PCR, Sputum BTWGS Bacterial Typing, Whole Genome Sequencing, Varies LENT Enterovirus, Molecular Detection, PCR, MGRP Mycoplasma genitalium, Varies Molecular Detection, PCR, Varies BARTB , Molecular Detection, PCR, Blood LEBV Epstein-Barr Virus (EBV), MHRP Metamycoplasma hominis, Molecular Detection, PCR, Varies Molecular Detection, PCR, Varies BARRP Bartonella, Molecular Detection, PCR, Varies EBVQN Epstein-Barr Virus DNA Detection MPRP Mycoplasmoides pneumoniae, and Quantification, Plasma Molecular Detection, PCR, Varies PBKQN BK Virus DNA Detection and Quantification, Plasma GIP Gastrointestinal Pathogen Panel, PCR, PARVP Parvovirus B19, Molecular Detection, Feces PCR, Plasma UBKQN BK Virus DNA Detection and Quantification, Random, Urine GNRG Gram-Negative Bacillus Antimicrobial PARVO Parvovirus B19, Molecular Detection, Resistance Genes, PCR Panel, Varies PCR, Varies BPRP and , Molecular Detection, HERPB Herpes Simplex Virus 1 and 2, PNRP Pneumocystis jiroveci, PCR, Varies Qualitative PCR, Blood Molecular Detection, PCR, Varies BMIYB Borrelia miyamotoi Detection PCR, Blood HERPV Herpes Simplex Virus 1 and 2, RESLR Respiratory Pathogen Panel, PCR, Varies Qualitative PCR, Varies BMIYC Borrelia miyamotoi Detection PCR, RP Respiratory Panel, PCR, Nasopharyngeal HSVC Herpes Simplex Virus (HSV), Spinal Fluid STFRP Shiga Toxin, Molecular Detection, PCR, Molecular Detection, PCR, Spinal Fluid BRBPS Broad Range Bacterial PCR and Feces HBRP Histoplasma capsulatum/Blastomyces Sequencing, Varies TKPNL Tick-Borne Panel, Molecular Detection, species, Molecular Detection, PCR, Varies CAURB Candida auris, Molecular Detection, PCR, PCR, Blood HHV6 Human Herpesvirus-6, Molecular Blood PTOX Toxoplasma gondii, Molecular Detection, Detection, PCR, Plasma CAURP Candida auris, Molecular Detection, PCR, PCR, Varies HHV6V Human Herpesvirus-6, Molecular Random, Urine TOXB Toxoplasma gondii, Molecular Detection, Detection, PCR, Spinal Fluid CAURS Candida auris Surveillance, PCR, Blood FLUMS Influenza Virus Type A and Type B, Molecular Detection, PCR, Varies WHIPB Tropheryma whipplei, and Respiratory Syncytial Virus (RSV), CHIKS Chikungunya Virus, PCR, Molecular Detection, PCR, Blood Molecular Detection, PCR, Varies Molecular Detection, Serum TWRP Tropheryma whipplei, FLUNP Influenza Virus Type A and Type CHIKC Chikungunya Virus, PCR, Molecular Detection, PCR, Varies B, and Respiratory Syncytial Virus Molecular Detection, Spinal Fluid (RSV), Molecular Detection, PCR, URRP Ureaplasma species, Molecular Detection, CDFRP Clostridioides difficile Toxin, Nasopharyngeal Swab PCR, Varies Molecular Detection, PCR, Feces LCJC JC Virus, Molecular Detection, PCR, VRERP Vancomycin-Resistant Enterococcus, CIMRP Coccidioides immitis/posadasii, Spinal Fluid Molecular Detection, PCR, Varies Molecular Detection, PCR, Varies KKRP kingae, Molecular Detection, LVZV Varicella-Zoster Virus, Molecular CBBRP (), PCR, Varies Detection, PCR, Varies Molecular Detection, PCR, Blood KNSRP Carbapenemase WNCSF West Nile Virus, RNA, PCR, CBSRP Coxiella burnetii (Q Fever), (blaKPC) and New Delhi Metallo-beta- Molecular Detection, Spinal Fluid Molecular Detection, PCR, Serum Lactamase (blaNDM) Surveillance, WNVBL West Nile Virus, RNA, PCR, CBRP Coxiella burnetii (Q fever), PCR, Varies Molecular Detection, Blood Molecular Detection, PCR, Varies LEGRP Legionella species, Molecular Detection, WNVS West Nile Virus, RNA, PCR, CMVNG Cytomegalovirus (CMV) Drug Resistance, PCR, Varies Molecular Detection, Serum Next-Generation Sequencing, Plasma PBORB Lyme Disease, Molecular Detection, PCR, WNVUR West Nile Virus, RNA, PCR, CMVQN Cytomegalovirus (CMV) DNA Detection Blood Molecular Detection, Random, Urine and Quantification by Real-Time PCR, PBORR Lyme Disease, Molecular Detection, PCR, RZIKS Zika Virus, PCR, Molecular Detection, Plasma Varies Serum LCMV Cytomegalovirus (CMV), LCMAL , Molecular Detection, PCR, Varies RZIKU Zika Virus, PCR, Molecular Detection, Molecular Detection, PCR, Varies Random, Urine

T244 Page 2 of 5 MC0767rev0821 Patient Information (required) Patient ID (Medical Record No.) Client Account No.

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SPECIMEN CULTURES (RAW SPECIMEN) FUNID Culture Referred for Identification, Fungus DIRECT AND SPECIAL EXAMINATION Bacterial Cultures CTBID Culture Referred for Identification, SFUNG 1,3-Beta-D-Glucan (Fungitell), Serum Mycobacterium and Nocardia, Varies GENS Bacterial Culture, Aerobic with ACARP Acanthamoeba species, Antimicrobial Susceptibilities, Varies TBIDS Culture Referred for Identification, Molecular Detection, PCR, Ocular Mycobacterium and Nocardia with ANAES Bacterial Culture, Anaerobic with FLARP Free-Living Amebae, Molecular Detection, Antimicrobial Susceptibility Testing, Varies Antimicrobial Susceptibilities, Varies PCR, Varies IDENT Organism Referred for Identification, CFRCS Bacterial Culture, Cystic Fibrosis with ALGAL Galactose-Alpha-1,3-Galactose Aerobic Antimicrobial Susceptibilities, Varies (Alpha-Gal), IgE, Serum ANIDE Organism Referred for Identification, LEGI Legionella Culture, Varies APGAL Galactose-Alpha-1,3-Galactose Anearobic Bacteria HELIS Culture with (Alpha-Gal) Mammalian Meat Allergy Profile, Serum Antimicrobial Susceptibilities, Varies ANTIMICROBIAL SUSCEPTIBILITY GSBV Gram Stain for Bacterial Vaginosis, Varies Fungal Cultures Identification of organism submitted: HPFRP Helicobacter pylori with FBL Fungal Culture, Blood Antimicrobial Susceptibility, MMLRG Clarithromycin Resistance Prediction, Acid-Fast Bacilli, Rapidly Growing, Varies FDERM Fungal Culture, Dermal Molecular Detection, PCR, Feces MMLSG Antimicrobial Susceptibility, FGEN Fungal Culture, Routine UBT Helicobacter pylori Breath Test Acid-Fast Bacilli, Slowly Growing, Varies FVAG Fungal Culture, Vaginal SHPV Human Papillomavirus (HPV) ZMMLS Antimicrobial Susceptibility, DNA Detection with Genotyping, FS Fungal Smear, Varies Aerobic Bacteria, MIC, Varies High-Risk Types by PCR, SurePath, Varies Mycobacterial Cultures MMLSA Antimicrobial Susceptibility, HPV Human Papillomavirus (HPV) SAFB Acid-Fast Smear for Mycobacterium, Anaerobic Bacteria, MIC, Varies DNA Detection with Genotyping, Varies TB1LN Antimicrobial Susceptibility, High-Risk Types by PCR, ThinPrep, Varies TBIDS Culture Referred for Identification, Mycobacterium tuberculosis Complex, LAGU Legionella Antigen, Random, Urine Mycobacterium and Nocardia with First Line, Varies SSF1 Nocardia Stain, Varies Antimicrobial Susceptibility Testing, Varies MMLNS Antimicrobial Susceptibility, CTB Mycobacteria and Nocardia Culture, Varies Nocardia species and other SPN Pneumocystis Smear, Varies Aerobic Actinomycetes, Varies CTBBL Mycobacterial Culture, Blood QFT4 QuantiFERON-TB Gold Plus, Blood MMLYP Antimicrobial Susceptibility Panel, Yeast, Viral Cultures ROTA Rotavirus Antigen, Feces Varies VIRNR Viral Culture, Non-Respiratory, Varies CARNP Carbapenemase Detection-Carba NP Test, CHLAMYDIA TRACHOMATIS, Varies ISOLATED ORGANISM REFERRED NEISSERIA GONARRHOEAE, FOR IDENTIFICATION KPNRP KPC (blaKPC) and NDM (blaNDM) AND TRICHOMONAS VAGINALIS in Gram-Negative Bacilli, CGRNA Chlamydia trachomatis and Neisseria All of the following information must be submitted Molecular Detection, PCR, Varies to obtain identification of any organism submitted. gonorrhoeae, Nucleic Acid Amplification, MTBPZ Mycobacterium tuberculosis Complex, Varies Transport Medium Pyrazinamide Resistance by CTRNA Chlamydia trachomatis, Nucleic Acid pncA DNA Sequencing, Varies Amplification, Varies Recovery Medium OXVRP Oxacillin-Hydrolyzing Beta-Lactamase GCRNA , Nucleic Acid (blaOXA-48-like) and Verona Integron- Amplification, Varies Encoded Metallo-Beta-Lactamase Extent of Identification (blaVIM) in Gram-Negative Bacilli, MGRNA Neisseria gonorrhoeae, Miscellaneous Molecular Detection, PCR, Varies Sites, Nucleic Acid Amplification, Varies MCRNA Chlamydia trachomatis, Miscellaneous Date Collected (mm-dd-yyyy) OVSRP Oxacillin-Hydrolyzing Beta-Lactamase (blaOXA-48-like) and Verona Integron- Sites, Nucleic Acid Amplification, Varies Encoded Metallo-Beta-Lactamase MCTGC Chlamydia trachomatis and Suspect Brucella, Fancisella, Burkholderia pseudomallei, (blaVIM) DNA Surveillance, PCR, Varies Neisseria gonorrhoeae, Miscellaneous Bacillus anthracis, ? Yes No TBNGS Mycobacterium tuberculosis Complex, sites, Nucleic Acid Amplification, Varies Description (Gram reaction, Morphology, tests performed) Molecular Detection of Drug Resistance TVRNA Trichomonas vaginalis, Nucleic Acid Markers, Whole Genome Sequencing, Amplification, Varies Varies MTRNA Trichomonas vaginalis, Nucleic Acid TBPZA Susceptibility, Mycobacterium tuberculosis Amplification, Varies Complex, Pyrazinamide, Varies TB2LN Susceptibility, Mycobacterium tuberculosis Complex, Second Line, Varies VRERP Vancomycin-Resistant Enterococcus, Molecular Detection, PCR, Varies

T244 Page 3 of 5 MC0767rev0821 Patient Information (required) Patient ID (Medical Record No.) Client Account No.

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PARASITOLOGY PLFA Cryptococcus Antigen Screen, MONOS Infectious Mononucleosis, Rapid Test, Lateral Flow Assay, Pleural Fluid Serum CRYPS Cryptosporidium Antigen, Feces PLFAT Cryptococcus Antigen Titer, LAGU Legionella Antigen, Random, Urine CYCL Cyclospora Stain , Feces Lateral Flow Assay, Pleural Fluid SLEG (Legionnaires LEU Fecal Leukocytes, Feces SLFAT Cryptococcus Antigen Titer, Disease), Antibody, Serum FIL Filaria, Blood Lateral Flow Assay, Serum LEIS Leishmaniasis (Visceral) Antibody, Serum GIAR Giardia Antigen, Feces CLFAT Cryptococcus Antigen Titer, LEPDT Leptospira, IgM, Serum LMALP Malaria PCR with Parasitemia Reflex, Lateral Flow Assay, Spinal Fluid LNBAB Lyme Central Nervous System Varies ULFA Cryptococcus Antigen Screen, IgG with Antibody Index Reflex, Serum Lateral Flow Assay, Random, Urine MTBS Microsporidia Stain, Varies and Spinal Fluid SLFA Cryptococcus Antigen Screen with Titer, OAP Ova and Parasite, Concentrate and LYWB Lyme Disease Antibody, Immunoblot, Serum Permanent Smear, Microscopy, Feces Serum CLFA Cryptococcus Antigen Screen with Titer, PINW Pinworm Exam, Perianal ELYME Lyme Disease European Antibody Screen, Spinal Fluid MAL Rapid Malaria/Babesia Smear, Varies Serum LFACX Cryptococcus Antigen with Reflex, ELYMI Lyme Disease European Immunoblot, Spinal Fluid INFECTIOUS DISEASE SEROLOGY Serum CMVG Cytomegalovirus (CMV) Antibodies, IgG, ANAP Anaplasma phagocytophilum (Human LYME Lyme Disease Serology, Serum Serum Granulocytic ) Antibody, Serum ROPG (Rubeola) Antibodies, IgG, Serum CMVP Cytomegalovirus (CMV) Antibodies, IgM ARBOP Arbovirus Antibody Panel, IgG and IgM, and IgG, Serum ROM Measles (Rubeola) Antibodies, IgM, Serum Serum CMVM Cytomegalovirus (CMV) Antibodies, IgM, ROGM Measles (Rubeola) Virus Antibody, ABOPC Arbovirus Antibody Panel, IgG and IgM, Serum IgM and IgG, Serum Spinal Fluid DENVP Dengue Virus Antibody/Antigen Panel, MMRV Measles, Mumps, Rubella, and Varicella ASPBA Aspergillus Antigen, Bronchoalveolar Serum (MMRV) Immune Status Profile, Serum Lavage DENGM Dengue Virus Antibody, IgG and IgM, MMPGM Mumps Virus Antibody, IgM and IgG, ASPAG Aspergillus (Galactomannan) Antigen, Serum Serum Serum DNSAG Dengue Virus NS1 Antigen, Serum CMUMP Mumps Virus Antibodies, IgG and IgM, IgG Antibodies, Serum BABG Babesia microti Spinal Fluid DTABS Diphtheria/Tetanus Antibody Panel, Serum Antibody Panel, IgG and IgM, BART Bartonella MPPG Mumps Virus Antibody, IgG, Serum Serum DIPGS Diphtheria Toxoid IgG Antibody, Serum MMPM Mumps Virus Antibody, IgM, Serum BLAST Blastomyces Antibody, Enzyme EEEP Eastern Equine Encephalitis Antibody, Immunoassay, Serum IgG and IgM, Serum MYCO Mycoplasma pneumoniae Antibodies, IgG and IgM, Serum SBL Blastomyces Antibody Immunodiffusion, EEPC Eastern Equine Encephalitis Antibody Serum Panel, IgG and IgM, Spinal Fluid MMYCO Mycoplasma pneumoniae Antibodies, IgM, Indirect Immunofluorescence Assay, CBL Blastomyces Antibody Immunodiffusion, ECHNO Echinococcus Antibody, IgG, Serum Serum Spinal Fluid EHRCP Ehrlichia Antibody Panel, Serum PARVS Parvovirus B19 Antibodies, IgG and IgM, UBLAS Blastomyces Antigen, Quantitative, EHBAP Ehrlichia/Babesia Antibody Panel, Serum Enzyme Immunoassay, Random, Urine Immunofluorescence, Serum QFP Q Fever Antibody, IgG and IgM, Serum BORDG Bordetella pertussis Antibody, IgG, Serum EHRC (HME) Antibody, IgG, QFT4 QuantiFERON-TB Gold Plus, Blood BRUGM Brucella Antibody Screen, IgM and IgG, Serum Screen Response ELISA, Serum SAM Entamoeba histolytica Antibody, Serum RPRRT to Therapy, Serum BRUTA Brucella Total Antibody Confirmation, SEBV Epstein-Barr Virus (EBV) Antibody Profile, Rubella Antibodies, IgG, Serum Agglutination, Serum Serum RBPG Rubeola (Measles) Antibodies, CAVPC California Virus (La Crosse) Encephalitis EBVE Epstein-Barr Virus (EBV), IgG Antibody ROC Antibody Panel, IgG and IgM, Spinal Fluid to Early Antigen, Serum IgG and IgM, Spinal Fluid Influenza Virus Type A and Type B, CAVP California Virus (La Crosse) IgG and IgM, HIBSG influenzae Type B Antibody, FLUNP Serum IgG, Serum and Respiratory Syncytial Virus (RSV), Molecular Detection, PCR, CHIKV Chikungunya IgM and IgG, Antibody, Serum HSVG Herpes Simplex Virus (HSV) Type 1- and Nasopharyngeal Swab SCLAM Chlamydia Serology, Serum Type 2-Specific Antibodies, IgG, Serum STLP St. Louis Encephalitis Antibody, SCOC Coccidioides Antibody, Complement HICBL Histoplasma/Blastomyces Panel, IgG and IgM, Serum Fixation and Immunodiffusion, Serum Spinal Fluid STLPC St. Louis Encephalitis Antibody Panel, CCOC Coccidioides Antibody, Complement SHSTO Histoplasma Antibody, Serum IgG and IgM, Spinal Fluid Fixation and Immunodiffusion, Spinal Fluid CHIST Histoplasma Antibody, Spinal Fluid COXIS Coccidioides Antibody Screen with Reflex, UHIST Histoplasma Antigen, Random, Urine Serum

T244 Page 4 of 5 MC0767rev0821 Patient Information (required) Patient ID (Medical Record No.) Client Account No.

Patient Name (Last, First, Middle) Client Order No.

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BILHA Schistosoma species Antibody, IgG, ADDITIONAL TESTS Serum (INDICATE TEST NUMBER AND NAME) SFGP Group Antibody, IgG and IgM, Serum SSP Sporothrix Antibody, Serum SSPC Sporothrix Antibody, Spinal Fluid SPNC pneumoniae Antigen, Spinal Fluid SPNEU Streptococcus pneumoniae Antigen, Random, Urine STRNG Strongyloides Antibody, IgG, Serum TPPA Antibody, Treponema pallidum Particle Agglutination, Serum SYPHN Syphilis Total Antibody, Serum SYPHT Syphilis Total Antibody with Reflex, Serum TTIGS Tetanus Toxoid IgG Antibody, Serum TICKS Tick-Borne Disease Antibodies Panel, Serum TRCHG ToRCH Profile IgG, Serum TOXGP Toxoplasma gondii Antibody, IgG, Serum TXMGP Toxoplasma gondii Antibody, IgM and IgG, Serum TXM Toxoplasma gondii Antibody, IgM, Serum STRIC Trichinella Antibody, Serum CHAG Trypanosoma cruzi IgG Antibody ELISA, Serum TULAB Antibody, IgM and IgG, ELISA, Serum VZPG Varicella-Zoster Antibody, IgG, Serum VZGM Varicella-Zoster Antibody, IgM and IgG, Serum VZM Varicella-Zoster Virus (VZV) Antibody, IgM, Serum WEEP Western Equine Encephalitis Antibody, IgG and IgM, Serum WEEPC Western Equine Encephalitis Antibody Panel, IgG and IgM, Spinal Fluid WNS West Nile Virus Antibody, IgG and IgM, Serum WNC West Nile Virus Antibody, IgG and IgM, Spinal Fluid MZIKV Zika Virus IgM Antibody Capture ELISA, Serum

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