Quantitative Analysis of Adalimumab (Humira®) and Anti-Adalimumab Antibodies (LS-163)

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Quantitative Analysis of Adalimumab (Humira®) and Anti-Adalimumab Antibodies (LS-163) PRESCRIBER INFORMATION PATIENT INFORMATION Last Name: Last Name: First Name: First Name: Clinic: Sex: F M Address: Date of Birth: yyyy / mm / dd No Street Office Reference Number: City Prov. Postal code Tel: Health Insurance No.: (RAMQ, OHIP, etc.) Fax: Licence No. yyyy/mm/dd Signature: X Date SAMPLE COLLECTION TYPE OF SPECIMEN Serum: 1 mL DATE: ________/________/________ For optimal results, sample collection should be within 24-48 hours prior to the next Humira injection. Year Month Day RESULTS TRANSMISSION Results will be provided within 10 to 15 working days. Please note that the prescriber can elect to access patient results online. To request web access, please contact our customer service department. GD Specialized Diagnostics 3885 Industriel Blvd., Laval, Quebec, H7L 4S3 Tel: (450) 901-3071 / 1-888-988-1888 • Fax: (450) 663-4428 E-mail: [email protected] • Website: www.gamma-dynacare.com FOR INTERNAL USE ONLY Comments: __________________________________________________________________________ __________________________________________________________________________ This analysis is supported by an unrestricted grant provided by Abbvie. Rev. 2014SE30 PATIENT INSTRUCTIONS ONTARIO / QUEBEC For sample collecon, please go to the nearest Gamma‐Dynacare Paent Services Centre (no appointment required). For a list of locaons and hours, go to www.gamma‐dynacare.com or call 1‐888‐988‐1888. MANITOBA For sample collecon, please call (204) 944‐0757 ext. 7253 to make an appointment at the following Gamma‐Dynacare Paent Services Centre: 830 King Edward St., #100, Winnipeg, MB, R3H 0P4. SASKATCHEWAN For sample collecon, please go to one of the following Gamma‐Dynacare Paent Services Centres, from Monday to Friday (no appointment required): Saskatoon – 39‐23rd St East, #5, Saskatoon, SK S7K 0H6, tel: (306) 655‐4030 Regina – 2723 Avonhurst Dr, Regina, SK S4R 3J3, tel: (306) 766‐6977 ALBERTA Sample collecon centres are located throughout the province. To ﬁnd a locaon near you, please call 1‐888‐988‐1888. BRITISH‐COLUMBIA / NEW BRUNSWICK / NOVA SCOTIA / P.E.I. / NEWFOUNDLAND Please refer to our home collecon services described below. HOME COLLECTION SERVICES ACROSS CANADA GD Specialized Diagnoscs oﬀers home collecon services across Canada. A trained professional will come to your home to perform the blood draw and will then ship the sample to our laboratory. Contact our Customer Service Department at 1‐888‐988‐1888 to make an appointment. For more informaon or for any quesons, please contact our Customer Service Department at 1‐888‐988‐1888. .

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P.H.P. (Physician Health Program) Collection Site List.Xlsx
SITE STN CITY ADDRESS HOURS COMMENTS (hours of operation may be subject to change) LifeLabs Mon: 7:00 am - 2:00 pm 121 Wellington St. W., Suite 106 Tue: 7:00 am - 2:00 pm Closes at 12 pm BARRIE 1013 Barrie, ON L4N 1L2 Wed: 7:00 am - 11:00 am on 4th Wed of Tel: 705.728.1109 Thu: 7:00 am - 2:00 pm every month Fax: 705.728.4609 Fri: 7:00 am - 2:00 pm Acculab Mon: 9:00 am - 5:00 pm D-122 Commerce Park Drive Tue: 9:00 am - 5:00 pm BARRIE 3854 Barrie, ON, L4N 8W8 Wed: 9:00 am - 5:00 pm Tel: 866.991.1461 Thu: 9:00 am - 5:00 pm Fax: 705.999.8228 Fri: 9:00 am - 5:00 pm KAT Holdings Mon: 8:30 am - 4:00 pm 80 Harriett St. Tue: 8:30 am - 4:00 pm BELLEVILLE 757 Belleville, ON K8P 1V7 Wed: 8:30 am - 4:00 pm Tel: 613.966.9456 Thu: 8:30 am - 4:00 pm Fax: 613.967.9873 Fri: 8:30 am - 4:00 pm LifeLabs Mon: 9:00 am - 2:00 pm 210 Dundas St Tue: 9:00 am - 2:00 pm Closes at 2 pm on BELLEVILLE 690 Belleville, ON K8N 5G8 Wed: 9:00 am - 2:00 pm the 3rd Wed of Tel: 877.849.3637 Thu: 9:00 am - 2:00 pm every month Fax: 613.966.6068 Fri: 9:00 am - 2:00 pm Dynacare Mon: 8:00 am - 5:00 pm 55 Highway 118 W Tue: 8:00 am - 5:00 pm BRACEBRIDGE 36 52 Bracebridge, ON P1L 1T2 Wed: 8:00 am - 5:00 pm Tel: 705.645.7502 ext.
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