DERMATOIMMUNOLOGY ELISA TESTING

University of Colorado Dermatopathology Consultants Physical Address: University of Colorado Dermatopathology Consultants 1999 N. Fitzsimons Parkway Bioscience East, Suite 120 Aurora, CO 80045 Mailing Address: University of Colorado Dermatopathology Consultants 1999 N. Fitzsimons Parkway Bioscience East, Suite 120 Aurora, CO 80045

Dermatoimmunologists James E. Fitzpatrick, M.D. J. Clark Huff, M.D. Contact Information Phone: 303-344-1022 Fax: 303-344-0789 Please review form after printing

ELISA Specimen Information - Page 2

IMPORTANT! List any potentially infectious conditions the patient may have or be suspected to have Please use only one form per patient

ELISA Study B: Desmoglein 1 & 3 (DSG 1/3) BP 230 & 180 Clinical Photos: Enclosed with Specimen Sent Digitally

Site:  Collection Date:     CLINICAL FINDINGS

SENT Direct IF Indirect IF ICD-9 Code(s) 1. 2.