Testing with ZRT A Complete Guide to Using ZRT's Saliva, Blood & Dried Urine Testing in Your Practice Table of Contents Using ZRT Test Kits 2 Interpreting Your Results 4 ZRT Experts 6 Working with ZRT 8 Billing Practices 9 Overview of Kits 10 Directory of Tests & CPT Codes 12 General Information 14 WELCOME 1 Using ZRT Test Kits ZRT test kits offer simple and convenient home collection of saliva, dried blood spot or dried urine samples. The resources we offer make sample collection easy – whether you prefer watching a video or following detailed instructions. We also provide guidance for which patients will benefit from our testing and how to ensure they collect usable samples. Who to Test Candidates for hormone testing include men and women who exhibit symptoms including: Hot flashes Fibrocystic breasts Night sweats Breast cancer Foggy thinking Infertility Sleep disturbances PCOS Low libido / decreased sex drive Chronic stress Vaginal dryness Chronic fatigue Acne Weight gain, especially around the waist Increased body / facial hair Heart palpitations Heavy or irregular menses Dry skin / brittle nails PMS / PMDD Cold hands and feet Candidates for neurotransmitter testing include men, women and children who exhibit symptoms including: Anxiety Impulsivity Depression Insomnia Chronic fatigue OCD or ADHD Candidates for heavy metals & nutrients testing include men, women and children who: Have exposure to well water or aging pipes Consume foods like vegetables, rice and Live in an older home or industrial area seafood that may be tainted by heavy metals Have mercury dental work Smoke ZRT's Symptom Checklists will help identify which patients can benefit from testing and what type of testing is best for them - download those at zrtlab.com/resources 2 USING ZRT TEST KITS When to Test Fax your order to: 503.466.1636 Hormones Pre-menopausal women should collect saliva, blood or urine on days 19-21 of their cycle. Women with irregular cycles should collect 5 days before they think their period will start. Post-menopausal and non-cycling women can collect any day of the month. Men and children can collect any day of the month. See specialized instructions for those using hormones. Neurotransmitters Cycling women can collect any day they aren't bleeding. Non-cycling women, men and children can collect any day of the month. Heavy Metals & Nutrients Cycling women can collect urine any day they aren't bleeding. They can collect blood any day. Non-cycling women, men and children can collect urine or blood any day of the month. How to Test Once you have identified a patient who can benefit from testing, follow these steps: Alleviate Concerns Explain that the testing process is simple. ZRT saliva, blood spot, and urine test kits require no needles or lab visits. All samples except serum can be collected at home and returned to the lab by UPS. Walk Through the Test Kit Walk through the test kit with patients, pointing out: • Collection instructions • Saliva tubes / blood spot lancets and filter card / urine cards • Postage paid return label / mailer bag Review Collection Encourage patients to read collection instructions prior to testing, and fill out the paperwork the night before collection, leaving only Section 5 of the form (Sample Collection Dates and Times) to fill in the day of collection. Encourage patients to view ZRT’s collection videos online. Sample collection videos and extra copies of instructions are available for viewing at zrtlab.com/sample-collection USING ZRT TEST KITS 3 TEST REPORT | Results TEST REPORTGraphs continued 8605 SW Creekside Place Disclaimer: # 2018 08 08 222 S higher Graphs below represent averagesPhone: for healthy 503 individualsBeaverton, not using OR hormones. 97008 Supplem . Please see supplementation ranges and lab comments-466- if2445 results Fax: are 503 higher or lower than expec Ordering Provider: -466-1636 Getuwell Clinic John Getuwell, MD Samples Received Saliva Profile III # 2018 08 08 222 S 80 Saliva Testosterone 08/08/2018 Samples Collected entationSaliva ranges may be 70 - 08/05/18 06:05 Report Date Salivated. - 08/05/18 13:00 60 08/10/2018 Saliva - 08/05/18 18:40 Average Saliva - 08/05/18 21:46 50 Off Graph Patient Name: 25 Saliva DHEAS Saliva Profile40 III Patient Phone Number: pg/mL 55530 555 5555 20 Gender Last Menses20 Female 15 Understanding ZRT’s Test Report Unspecified Height DOB 10 Waist Unspecified ng/mL 7/13/1958 (60 yrs) Menses Status Unspecified 10 Postmenopausal0 Weight 10 20 TEST NAME 30Unspecified40 RESULTS | 08/05/18 50 60 5 Age 70 80 Salivary Steroids RANGE 90 100 Estradiol 12 Saliva Cortisol 0 10 20 2.2 30 40 10 50 Progesterone 0.8 60 70 -12 pg/mL Estrogen Rplcmnt (optimal 1.3 Age 80 833 90 100 Ratio: Pg/E2 8 200-3000 pg/mL -3.3) Topical, Troche, Vag Pg (10 Testosterone 6 379 -30mg) ng/mL Optimal: 100 -500 when E2 1.3 33 -3.3 pg/mL DHEAS 4 16-55 pg/mL (Age Dependent) 1.5 L Cortisol 2 2-23 ng/mL (Age Dependent) Cortisol 7.0 03:00 3.7-9.5 ng/mL 06:00 (morning) 09:00 2.2 12:00 Cortisol 15:00 1.218:00-3.0 ng/mL 21:00 (noon) Time of Day 00:00 0.9 03:00 Cortisol 0.6 -1.9 ng/mL (evening) <dL = Less than the detectable limit of the lab. 0.9 0.4-1.0 ng/mL N/A = Not applica (night) Therapies ble; 1 or more values used in thi s calculation is less than the detectable lim 1mg topical Biestrogen (80/20 E3 + E2) (compounded) (24 Hours Last Used)30mg topical Progesterone ( it. H = High. Testosterone (compounded) (24 Hours Last Used) topical DHE L = Low. A (compounded) (24 Hours Last Used) compounded) (12 Hours Las t Used)0.5mg topical CLIA Lic # 38D0960950 9/14/2018 10:27:53 AM The above results and comments are for informational purposes only and are not to be construed as medical advice . Please consult your healthcare practitioner for CLIA Lic # 38D0960950 diagnosis and treatment. 9/14/2018 10:27:53 AM The above results and comments are for informational purposes only and are not to be construed as medical advice. Please consult your healthcare practitioner for David T. Zava, Ph.D. diagnosis and treatment. Laboratory Director © 1998-2018David ZRT T. Zava, La Ph.D. Laboratory Director 8605 SW Creekside Place borat ory, LLC. A ll rights reserved. A © 1998-2018 ZRT Laboratory, LLC. All rights reserved. lison McAllister, ND. Alison McAllister, (Ordering Provider unless(Ordering Provider unless ND. Beaverton, OR 97008 otherwise specified on pageotherwise 1) specified on1 pageof 4 1) 2 of 4 ZRT’sTEST REPORT test reports are thePhone: 503 -most466-2445 Fax: 503 comprehensive-466-1636 results available anywhere. # 2018 07 27 200 SB Samples Received Samples Collected Ordering Provider: 07/27/2018 Saliva - 07/24/18 08:05 OurSara Getuwell reports MD combine patients’ test levels with self-reportedSaliva - 07/24/18 12:10 symptoms that are then interpreted in a Report Date Saliva - 07/24/18 18:50 08/01/2018 Saliva - 07/24/18 23:15 set of individualized comments — all giving healthBlood careSpot - 07/24/18 providers 08:00 unparalleled insight into patient conditions. Key features of the ZRT report include: Patient Name: Weight Management Patient Phone Number: 555 555 5555 Gender Last Menses Height Waist FemaleResultsUnspecified 5 ft 5 in 32 in DOB Menses Status Weight BMI 3/22/1961 (57 yrs) Hysterectomy (ovaries removed) 170 lb 28.3 Results for each test are shown on a color-coded slider. TEST NAME RESULTS | 07/24/18 04/09/18 RANGE Salivary Steroids Red: Outside the Range Estradiol 2.2 4.7 0.8-12 pg/mL Estrogen Rplcmnt (optimal 1.3-3.3) 8605 SW Creekside Place Yellow: High/Low Normal (1) Beaverton, OR 97008 (2) 30-300 pg/mL Oral Progesterone (100-300 mg) Progesterone 73(1) 22 TEST REPORT Phone: 503-466-2445 Fax: 503-466-1636 (2) 12-100 pg/mL Postmenopausal Green: Within Range Ratio: Pg/E2 33 L 5 L Optimal: 100-500 when E2 1.3-3.3 pg/mL # 2018 07 27 200 SB Samples Received Samples Collected Testosterone 07/27/201835 15 L 16-55 pg/mL (Age Dependent) Ordering Provider: Saliva - 07/24/18 08:05 ZRT is one of the few labs able to show historical test results, if available. Saliva - 07/24/18 12:10 Sara Getuwell MD DHEAS 5.0 2.3 2-23 ng/mL (Age Dependent) Report Date Saliva - 07/24/18 18:50 08/01/2018 These results are displayed directly next to the current results, so it’s Cortisol 9.0Saliva - 07/24/188.1 23:153.7-9.5 ng/mL (morning) Blood Spot - 07/24/18 08:00 easy to see changes over time. Cortisol 1.5 1.9 1.2-3.0 ng/mL (noon) Cortisol 0.7 0.5 L 0.6-1.9 ng/mL (evening) Patient Name: Weight Management Cortisol 0.4 0.4 0.4-1.0 ng/mL (night) Patient Phone Number: 555 555 5555 Blood Spot Gender Last Menses VHeightitamin D, 25-OH,W D2aist <4 <4 <4 if not supplementing (< 10 nmol/L) Female Unspecified 5 ft 5 in 32 in Ranges 15 Vitamin D, 25-OH, D3 46 L 20-80 ng/ml (50-200 nmol/L) DOB Menses Status Weight BMI Vitamin D, 25-OH, 3/22/1961 (57 yrs) Hysterectomy (ovaries removed) 170 lb 28.3 15 L Total 46 20-80 ng/ml (50-200 nmol/L) ZRT reports the normal / expected range of each marker tested.