HORIZON 4 (SMA, CF, FRAGILE X, DMD)

Specimen Required
Special kit required for blood collection. Please call lab for kit.

Rejection Criteria
Specimens received refrigerated or frozen.

Methodology
Copy number analysis, Next-generation sequencing, Polymerase chain reaction, Genotypeing, Sanger sequencing

Stability
Room temperature: 7 days; Refrigerated: Unacceptable; Frozen: Unacceptable

Reference Range
See Report

Performed
Monday-Friday

Turnaround Time12-16 days
Test CodeHCS4
CPT-4 Code (s)
81479 (or 81220, 81243, 81329, 81408, 81161)
ZBAQD
LOINC Codes
Tay-Sachs Enzyme Add-on
Acceptable Prompt Responses:
No
Yes   Not Available  
Is this patient pregnant?
Acceptable Prompt Responses:
No
Yes   Not Available  
Patient currently using hormonal medications?
Acceptable Prompt Responses:
No
Yes
Unsure   Not Available  
Ethnicity of Patient
Acceptable Prompt Repsonses:
African American
Ashkenazi Jewish
Caucasian
E Asian
Frnch Canadian/Cajun
Hispanic
Mediterranean
South-East Asian
Sephardic Jewish
Other   Not Available  
Zip code of the ordering facility   Not Available  
Test delivery fax/email   Not Available  
Did this patient sign the Patient Acknowlegement?
Acceptable Prompt Responses:
No
Yes   Not Available  
Did ordering clinician sign Statement of informed Consent?
Acceptable Prompt Responses:
No
Yes   Not Available  
What type of billing?
Acceptable Prompt Responses:
Bill Insurance
Bill Clinic
Self Pay   Not Available  
Partner's name (LAST NAME, FIRST NAME)   Not Available  
Partner's DOB (MMDDYYYY)   Not Available  
Cystic Fibrosis   Not Available  
Duchenne/Becker Muscular Dystrophy   Not Available  
Fragile X Syndrome   Not Available  
Spinal Muscular Atrophy   Not Available  
Tay-Sachs Disease (DNA and enzyme)   Not Available  
Tay-Sachs Disease (DNA only)   Not Available  
Tay-Sachs Disease (enzyme only)   Not Available  
Panel Notes   Not Available  
Report Note   Not Available  
Footnotes   Not Available  
References   Not Available  
Approvals   Not Available  
Contacts   Not Available  

Warde
Medical
Laboratory