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Requested Laboratory
Testing |
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Edward Lichten, M.D., PC
189 Townsend Street-2nd floor
Birmingham, MI 48009
248.593.9999 |
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OVERVIEW: Dr. EDWARD LICHTEN's PATIENTS-
are
REQUIRED to have these
Laboratory Tests of the endocrine system. These tests assist in the
diagnosis of core disease and must be evaluated prior to any medical
intervention for present or chronic therapy. Be sure to bring your photo ID
and this form to the drawing station. For the closest drawing station
for LabCorp Laboratories first
then click [Find a Lab
Near You].
Lab Reports are to
be sent to: and Faxed to:
Edward Lichten, M.D.,
P.C. Fax:
248.593.9037
189 Townsend St. Second Floor
Birmingham, MI 48009
[_X_] LICHTEN LAB PROFILE
| CBC |
Comprehensive Metabolic Panel |
| Hepatitis Screen
(optional) |
Lipids -Triglycerides, Chol, HDL |
| C-reactive protein; Sed Rate |
Calciferol Vitamin D3 0,25 OH |
| Cortisol |
Thyroid Stimulating Hormone |
| DHEA-S |
TSH, T3 and T4 free |
| Estradiol |
Thyroid antibodies |
| Testosterone |
Thyroid peroxidase antibodies |
| Sex Hormone Bind. Globulin |
Iron, Iron Binding Capacity |
| IGF-1 |
Homocysteine |
| Insulin fasting |
Hemoglobin A1c |
| FSH, LH |
Progesterone (women-day
23) |
| Prolactin |
PSA men only |
| Pregnenolone |
RBC magnesium, Zinc,
Copper Chromium |
Signature on file:
Licensed Physician: Edward
Lichten, MD
California Physician:
Michigan Physician:
Ohio Physician:
If your state requires laboratory
tests to be ordered
by a health professional boarded in your State of residence, please have
the necessary signature and information completed below:
Dr. Signature:_____________________
Date:__________
State: ______________
Board Number: _______________
Dr. Address: ____________________________________
Dr. City/ State/Zip: ____________________
___________
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The following test is for those individuals who are
diabetic or concerned about becoming diabetic.
Testing is as recommended in Dr. Lichten's Textbook
of Bio-Identical Hormones.
LABORATORY PROFILE for DIABETES MELLITUS
For those with diabetes defined by an elevated glycogenated hemoglobin
(HgB-A1c >6), a FASTING, 3 hour glucose tolerance test (GTT-I) with insulin drawn at
0, 1, 2, and 3 hours is required before treatment. Check the box if
DIABETIC.
[___] GTT-I
THREE HOUR
GLUCOSE TOLERANCE TEST
1. Fasting Glucose and Fasting Insulin
2. 75 gram Glucola oral glucose load
3. 3-hour Glucose Tolerance Test with 1, 2, and 3 hour insulin
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