Requested Laboratory Testing

Edward Lichten, M.D., PC
555 S. Old Woodward #700
Birmingham, MI 48009 
248.593.9999

Basic Lichten Panel

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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 PRINT THIS PAGE then  click [Find a Lab Near You].
Lab Reports are to be sent to:                           Fax: 248.593.9037

Edward Lichten, M.D., P.C.       
555 South Old Woodward #700
Birmingham, MI 48009                    

REQUESTED LABORATORY TESTS

  REQUESTED LABORATORY TESTS
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
Epstein Barr IGM, IGG, early Antigen Reverse T3 (reverse tri-iodothyroine)
Signature on file.
 Licensed Physician: 

Edward Lichten, MD
DIAGNOSTIC CODES:  Women
780.79, 244.9, 255.9; 		 DIAGNOSTIC CODES: (men) 257.2

 

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/: ______________________ Zipcode: ___________

 

 
[   ] ONLY IF  PATIENT IS DIABETIC   DRINK 75 GRAM GLUCOLA AFTER 1ST SET OF BLOOD TUBES DRAWN
THREE HOUR GLUCOSE TOLERANCE TEST with REPRESENTATIVE GLUCOSE LEVEL
0 HOUR [SPECIMEN #1] GLUCOSE AND INSULIN LEVEL
1 HOUR [SPECIMEN #2] GLUCOSE AND INSULIN LEVEL
2 HOUR [SPECIMEN #3] GLUCOSE AND INSULIN LEVEL
3 HOUR [SPECIMEN #4] GLUCOSE AND INSULIN LEVEL
   
Explantion:
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.		 CHECK WITH YOUR REFERRING DOCTOR WHEN TEST COMPLETED  ( PLUS 4 DAYS) FOR RESULTS.
Signature on file.
 Licensed Physician: 
Edward Lichten, MD		 DIAGNOSTIC CODES:  250.0 Diabetes