Requested Laboratory Testing

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

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:        and Faxed to:

Edward Lichten, M.D., P.C.       Fax: 248.593.9037
555 South Old Woodward #700
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:

DIAGNOSTIC CODES: 780.79, 244.9, 255.9 (women) 257.2 (men only)

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: ____________________ ___________

.
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