TESTING WITH ZRT. A Complete Guide to Using ZRT's Saliva, Blood & Dried Urine Testing in Your Practice

Transcription

1 TESTING WITH ZRT A Complete Guide to Using ZRT's Saliva, Blood & Dried Urine Testing in Your Practice

2 Table of Contents Using ZRT Test Kits 2 Interpreting Your Results 4 ZRT Experts 6 Educational Resources 8 Working with ZRT 10 Billing Practices 11 Reordering Kits 12 Directory of Tests & 14 General Information 16 WELCOME 1

3 USING ZRT TEST KITS ZRT test kits offer simple and convenient home collection of saliva, dried blood spot or dried urine samples. The resources we offer make sample collection easy whether you prefer watching a video or following detailed instructions. We also provide guidance for which patients will benefit from our testing and how to ensure they collect usable samples. Who to Test Candidates for hormone testing include men and women who exhibit symptoms including: Hot flashes Fibrocystic breasts Night sweats Breast cancer Foggy thinking Infertility Sleep disturbances PCOS Low libido / decreased sex drive Chronic stress Vaginal dryness Chronic fatigue Acne Weight gain, especially around the waist Increased body / facial hair Heart palpitations Heavy or irregular menses Dry skin / brittle nails PMS / PMDD Cold hands and feet Candidates for neurotransmitter testing include men, women and children who exhibit symptoms including: Anxiety Impulsivity Depression Insomnia Chronic fatigue OCD or ADHD Candidates for heavy metals & nutrients testing include men, women and children who: Have exposure to well water or aging pipes Live in an older home or industrial area Have mercury dental work Consume foods like vegetables, rice and seafood that may be tainted by heavy metals Smoke ZRT's Symptom Checklists will help identify which patients can benefit from testing and what type of testing is best for them - download those at zrtlab.com/resources 2 USING ZRT TEST KITS

4 When to Test Fax your order to: Hormones Pre-menopausal women should collect saliva, blood or urine on days of their cycle. Women with irregular cycles should collect 5 days before they think their period will start. Post-menopausal and non-cycling women can collect any day of the month. Men and children can collect any day of the month. See specialized instructions for those using hormones. Neurotransmitters Cycling women can collect any day they aren't bleeding. Non-cycling women, men and children can collect any day of the month. Heavy Metals & Nutrients Cycling women can collect urine any day they aren't bleeding. They can collect blood any day. Non-cycling women, men and children can collect urine or blood any day of the month. How to Test Once you have identified a patient who can benefit from testing, follow these steps: Alleviate Concerns Explain that the testing process is simple. ZRT test kits require no needles or lab visits. All samples can be collected at home and returned to the lab by UPS. Walk Through the Test Kit Walk through the test kit with patients, pointing out: Collection instructions Saliva tubes / blood spot lancets and filter card / urine cards Postage paid return label / mailer bag Review Collection Encourage patients to read collection instructions prior to testing, and fill out the paperwork the night before collection, leaving only Section 5 of the form (Sample Collection Dates and Times) to fill in the day of collection. Encourage patients to view ZRT s collection videos online. Sample collection videos and extra copies of instructions are available for viewing at zrtlab.com/sample-collection USING ZRT TEST KITS 3

5 # Understanding ZRT s Test Report TEST REPORT # S Ordering Provider: Getuwell Clinic John Getuwell, MD TEST REPORT Results continued Graphs Patient Name: Saliva Profile III Patient Phone Number: Gender Female DOB 7/13/1958 (60 yrs) Disclaimer: Graphs below represent averages for healthy individuals not using hormones. Supplementation ranges may be higher. Please see supplementation ranges and lab comments if results are higher or lower than expected. pg/ml Last Menses Unspecified Menses Status Postmenopausal Saliva Testosterone Weight Unspecified TEST NAME RESULTS 08/05/18 RANGE Salivary Steroids Height Waist Unspecified Unspecified Age 8605 SW Creekside Place Beaverton, OR Phone: Fax: Samples Received 08/08/2018 Report Date 08/10/2018 ng/ml Samples Collected Saliva - 08/05/18 06:05 Saliva - 08/05/18 13:00 Saliva - 08/05/18 18:40 Saliva - 08/05/18 21:46 Saliva DHEAS Saliva Profile III S Average Off Graph 12 Saliva Cortisol Estradiol pg/ml Estrogen Rplcmnt (optimal ) Progesterone pg/ml Topical, Troche, Vag Pg (10-30mg) Age Ratio: Pg/E2 379 Optimal: when E pg/ml ng/ml Testosterone pg/ml (Age Dependent) DHEAS 1.5 L Cortisol ZRT s test reports are the most comprehensive results available anywhere. Our reports combine patients test levels with self-reported symptoms that are then interpreted in a set of individualized comments all giving health care providers unparalleled insight into patient conditions. Key features of the ZRT report include: Results 3/22/1961 (57 yrs) Hysterectomy (ovaries removed) 170 TEST NAME RESULTS 07/24/18 04/09/18 R Salivary Steroids Estradiol Progesterone 73 (1) 22(2) ( ( Ratio: Pg/E2 33 L 5 L O Testosterone L 1 DHEAS Cortisol Cortisol Results for each test are shown on a color-coded slider. Red: Outside the Range Yellow: High/Low Normal Green: Within Range ZRT is one of the few labs able to show historical test results, if available. These results are displayed directly next to the current results, so it s easy to see changes over time. Cortisol L 0 Cortisol Blood Spot Ranges 8 RANGE pg/ml Estrogen Rplcmnt (optimal ) (1) pg/ml Oral Progesterone ( mg) (2) pg/ml Postmenopausal Optimal: when E pg/ml pg/ml (Age Dependent) 2-23 ng/ml (Age Dependent) ng/ml (morning) ng/ml (noon) ng/ml (evening) ZRT reports the normal / expected range of each marker tested. Note: If applicable, optimal ranges are provided. Reference ranges are observed ranges based on collected laboratory data. Unlike other labs, patients do not need to stop hormone supplementation to use ZRT s testing because we have ranges adjusted for age, menstrual status and supplementation types. This is the ideal method for tracking the effectiveness of hormone treatments. Providers can opt to show all reference ranges for the tests included on a separate page of the report. Therapies Therapies 07/24/2018: 0.5mg topical Biestrogen (1:1 50/50 E3 + E2) (compounded) (23 Ho 0.5mg topical Testosterone (compounded) (22 Hours Last Used)10mg topical DH (Pharmaceutical) (1 Days Last Used)5000IU oral Vitamin D (unknown type) (OTC 04/09/2018: 1mg oral Estradiol (compounded) (23 Hours Last Used) Graphs ZRT reports display patient-provided supplementation information (hormone, dose, delivery, timing). 4 UNDERSTANDING ZRT S TEST REPORT

6 CLIA Lic # 38D /23/2018 2:19:07 PM CLIA Lic # 38D /23/2018 2:19:07 PM The above results and comments are for informational purposes only and are not to be construed as medical advice. Please consult your healthcare practitioner for diagnosis and treatment. The above results and comments are for informational purposes only and are not to be construed as medical advice. Please consult your healthcare practitioner for David T. Zava, Ph.D. Laboratory Director David T. Zava, Ph.D. Laboratory Director Alison McAllister, ND. (Ordering Provider unless otherwise specified on page 1) Alison McAllister, ND. (Ordering Provider unless otherwise specified on page 1) Understanding ZRT s Test Report Graphs ng/ml Saliva Cortisol 03:00 06:00 09:00 12:00 15:00 18:00 21:00 00:00 03:00 Time of Day Graphs show reported levels by age or time to assist interpretation. For hormones that vary by time of day like cortisol and melatonin, the graph shows the range as it changes over the course of a day and the test results are plotted on the graph according to the actual time of day the sample was collected. Ranges within the graphs are color-coded to show the degree of variation from the center of the normal range. For hormones that vary in level with age, reports include graphs based on our database of testers not using hormone supplementation, showing the variation in levels with age. The test result is marked on each graph to indicate where the result falls in relation to the observed range for the tester s actual age. Symptoms Disclaimer: Symptom Categories below show percent of symptoms self-reported by the patient compared to total available symptoms for each category. For detailed information on category breakdowns, go to Aches and Pains Acne Allergies Anxious Bleeding Changes Blood Pressure High Blood Pressure Low Blood Sugar Low Body Temperature Cold Bone Loss Breast Cancer Breasts - Fibrocystic Breasts - Tender Chemical Sensitivity Cholesterol High Constipation Depressed Fatigue - Evening Fatigue - Morning Fibromyalgia Foggy Thinking Goiter Hair - Dry or Brittle Hair - Increased Facial or Body Hair - Scalp Loss Headaches Hearing Loss Heart Palpitations Hoarseness Hot Flashes Incontinence Infertility Irritable Libido Decreased Memory Lapse Mood Swings Muscle Size Decreased Nails Breaking or Brittle Nervous Night Sweats Numbness - Feet or Hands TEST REPORT Patient Reported Symptoms # SB SYMPTOM CATEGORIES RESULTS 07/24/18 04/09/18 Estrogen / Progesterone Deficiency 22% 40% Estrogen Dominance / Progesterone Deficiency 20% 34% Low Androgens (DHEA/Testosterone) 37% 58% High Androgens (DHEA/Testosterone) 11% 12% Low Cortisol 23% 33% High Cortisol 29% 56% Hypometabolism 21% 32% Metabolic Syndrome 38% 49% SYMPTOM CHECKLIST 68 symptoms self-reported by patient. Symptoms rated mild, moderate or severe. Patient symptoms are summarized into 8 hormone imbalance conditions and scored with red, yellow or green bars to indicate severity. Please refer to the Symptom Guide for details about symptom categories. 3 of 5 Comments Vaginal Dryness Water Retention Weight Gain - Hips Weight Gain - Waist Lab Comments Estradiol is within physiological range with topical estrogen replacement therapy. Maintaining healthy physiological estradiol levels promotes a healthy distribution of fat in hips, thighs, breasts, and subcutaneous tissues. Estrogen also supports good cholesterol ratios and enhances serotonin production, which helps regulate hunger and suppresses vasomotor symptoms (hot flashes and night sweats). For women who need to lose weight, estrogen levels may drop as weight drops, so low estrogen symptoms may appear as you achieve your weight loss goals. Progesterone is within expected physiological (luteal) range with oral progesterone supplementation. Oral supplementation results in a more rapid increase and clearance of progesterone with levels usually within the lower limits of the observed range > 12 hrs following supplementation. Within hr following oral progesterone therapy progesterone levels in the bloodstream and saliva have usually returned closer to baseline levels seen prior to progesterone supplementation; however, it is important to keep in mind that salivary levels depend on dosing (usually ranging from mg), and time from last use. Oral progesterone is usually more effective when used at night just before bed because metabolites formed in the gastrointestinal tract from progesterone (allopregnanolone) help with sleep. In this case it is best to collect saliva in the morning to allow an 6-10 hr time frame from last use of progesterone. If symptoms of estrogen/progesterone imbalance are not resolved with oral progesterone therapy it would be worthwhile to consider changing dosage or mode of delivery (e.g. transdermal progesterone instead of, or in combination with oral). If symptoms of estrogen imbalance remain problematic with the oral progesterone, it would be worthwhile to consider increasing or decreasing the estrogen level (assuming greater than the optimal range of pg/ml) or change the mode of progesterone delivery (eg. topical) to achieve an optimal Pg/E2 ratio of (note: if estradiol is within optimal range this optimal Pg/E2 ratio is likely achieved during the first 8 hours of oral progesterone supplementation). Testosterone is within physiological range with topical testosterone therapy. Adequate testosterone is necessary to build and maintain lean muscle mass which is directly tied to metabolic rate and calorie burning to help with weight loss. Muscle building exercise can help stimulate testosterone production and boost the metabolic rate. DHEAS is within range with topical DHEA therapy. DHEA partners with testosterone as an anabolic hormone to maintain muscle mass, bone density, metabolic rate, overall sense of well-being, and libido. Adequate DHEA (and testosterone) contributes to increased lean muscle which boosts metabolic rate and calorie burning to help with weight loss. DHEA may also enhance insulin sensitivity and naturally increases serotonin, which helps to control satiety and appetite. Cortisol is within high-normal range in the morning but drops precipitously to lower levels the remainder of the day. Suppression of cortisol may be due to androgen therapy (DHEA and/or testosterone) or to low adrenal reserve. In this individual a significant number of symptoms commonly associated with adrenal stressors are self reported. Under stress situations the adrenal glands normally respond by increasing cortisol output. However, when cortisol levels are within normal range under situations of excessive stress, as reported herein, this suggests they may be overworking to keep up with the demands of the stressors, which could eventually lead to adrenal exhaustion. HPA axis dysfunction is most commonly caused by stressors which include: psychological stress (emotional), sleep deprivation, poor diet (low protein-particularly problematic in vegetarians), nutrient deficiencies (particularly low vitamins C and B5), physical insults (surgery, injury), diseases (cancer, diabetes), chemical exposure (environmental pollutants, excessive medications), low levels of cortisol precursors (pregnenolone and progesterone) and pathogenic infections (bacteria, viruses and fungi). A normal daily output of cortisol is essential to maintain normal metabolic activity, help regulate steady state glucose levels (important for brain function and energy production), and optimize immune function. Depletion of adrenal cortisol synthesis by a chronic stressor, sleep deprivation, and/or nutrient deficiencies (particularly vitamins C and B5) often leads to symptoms such as fatigue, allergies (immune dysfunction), chemical sensitivity, cold body temp, and sugar craving. For additional information about strategies for 4 of 5 Individualized comments synthesize age, menstrual status, lab results, symptoms and current treatments. Relevant literature is cited within the comments. Self-reported symptoms do not influence lab results, but are included in the individualized comments as they relate back to lab results. ZRT providers can choose to include their professional comments in addition to, or in lieu of, the lab comments. Test results are generally available 3-5 business days after samples are received at the lab. UNDERSTANDING ZRT S TEST REPORT 5

7 UNMATCHED EXPERTISE Call to Speak to a Clinician Our clinical experts are available for peer-to-peer conversations that cover how to interpret our results and how to handle challenging patient cases. Our experts also perform collaborative clinical research with groups such as the CDC, NIH and academic research groups worldwide. We have published research in peer-reviewed journals and presented at scientific meetings. Clinical Experts Dr. Alison McAllister Head Clinician Dr. Alison McAllister is the lead clinical consultant for ZRT. She sees patients in her own practice several days a week, and has worked with ZRT for over 15 years helping hundreds of doctors understand hormone balance and the role that hormones, neurotransmitters and elements play in overall health. She is an expert in thyroid function, fertility and PCOS. In addition, Dr. McAllister also regularly lectures for groups such as the A4M and PCCA at industry conferences. Dr. Sherry LaBeck Clinical Consultant Dr. Sherry LaBeck has been with ZRT for over 12 years. Prior to being a clinical consultant she taught at the National University of Naturopathic Medicine in Portland OR and the Southwest College of Naturopathic Medicine in Tempe AZ. Her mission is to continue to expand education about hormones for health care providers around the country. Dr. Allison Smith Clinical Consultant After completing her N.D. at the National University of Naturopathic Medicine in Portland OR, Dr. Allison Smith worked in private practice focusing on primary care, women s health and dermatologic laser therapy. Since joining ZRT Laboratory s Clinical Consultant team, her focus has shifted to fostering the medical field s understanding of safe hormone therapies, sharing integrative approaches to health, and assisting in dissecting tough cases. Dr. Katrina Wilhelm Clinical Consultant Dr. Katrina Wilhelm is an experienced clinical consultant and lecturer with expertise on the HPA axis, hormones, and the role environmental exposures play in cardiometabolic and endocrine disorders. Previously, as the Medical Director for a nutraceutical company, she developed numerous clinical protocols and acted as the primary product formulator. Dr. Wilhelm maintains an international private practice specializing in anti-aging metabolic medicine. Staff clinicians available 9am-5pm PT, Mon-Fri at for peer-to-peer consultations no charge, no appointment necessary, no time limits 6 ZRT EXPERTS

8 Scientific Experts When called upon, our scientists are also ready to share their expertise on the technology behind the testing. ZRT's founder Dr. David Zava, a biochemist by trade and a teacher at heart, is animated when he talks about his work. He didn t start out trying to build a company as a researcher, he wanted to provide health care practitioners and patients with a deeper understanding of the role hormones play in wellness. The more he studied, the more test results he reviewed, and the more patient stories he heard, the more he knew he needed to channel his knowledge into something that enables people to be actively involved in their own health. To this day, he s continually searching to understand more fully how the world around us impacts our wellbeing, and how our lifestyle choices, environment and genetics impact the delicate balance of our hormones. His hands-on approach trickles down through ZRT Laboratory, so much so that the company is renowned for the way it supports people and their health on such a personal level. ZRT Laboratory embodies Dr. Zava s vision, and is recognized the world over as a team devoted to providing the most accurate results with the most educated insight into their meaning. Dr. Zava received his doctorate in Biochemistry from the University of Tennessee. Dr. Jillian Harrington Labratory Director Dr. Jillian Harrington is Laboratory Director at ZRT. She received her doctorate in Molecular Biology in 2006 from the University of Oregon. She spent 10 years as a Forensic Toxicologist and Forensic DNA Analyst with the Oregon State Police before moving into the clinical laboratory setting. She's worked for Oregon Health and Science University in the Knight Diagnostic Laboratory, where she developed and validated nextgeneration sequencing panels for rare, inherited genetic disorders. She's also worked as Assistant Laboratory Director at Molecular Testing Laboratories. There she oversaw genetic testing, molecular microbiology, and pain management toxicology testing. Dr. Kate Placzek Senior Research Scientist Dr. Kate Placzek is the Senior Research Scientist at ZRT Laboratory. Since 2015, Dr. Placzek has been combining clinical observation with published research findings to create innovative functional medicine test profiles used by practitioners around the globe. Prior to joining ZRT, she received her PhD in Medicinal Chemistry and Molecular Pharmacology at Purdue University and worked at Oregon Health and Science University as a postdoctoral researcher in endocrinology. Dr. Placzek is passionate about educating providers through blogs, webinars and lectures at national conferences. ZRT EXPERTS 7

9 EDUCATIONAL RESOURCES There s a lot to know about balancing hormones, neurotransmitters and elements, and learning the nuances of these interactions can take time. This is why ZRT offers a full library of free educational resources for both practitioners and patients including webinars, articles, handouts and videos. Many of these materials are available for view or download online at zrtlab.com, but we also provide a range of printed literature free of charge for providers to share with patients. For health care providers with questions about our testing methods, we offer scientific data sheets with references for each of our profiles in our resource library. Health Care Providers The ZRT Resource Library zrtlab.com/resources offers a wealth of educational options suitable for practitioners of all experience levels. These resources are all freely available for viewing or download 24x7x365. Our recommendations include: Level 1 HORMONES WEBINAR Unraveling the Confusion WEBINAR Physiologic Dosing GUIDE Steroid Hormone Testing Guide BLOG How a Symptom Checklist Can Help Determine a Test Method NEUROTRANSMITTERS Neurotransmitter Testing Patient Handout & Quiz WEBINAR Nuts & Bolts of Neurotransmitter Testing BLOG Getting the Most Out of Your Neurotransmitter Test WEBPAGE Dr. Kate's Case Study Library HEAVY METALS & NUTRIENTS Iodine Deficiency Handout WEBINAR Big 4 Toxic Metals BLOG Element Testing Why Sample Type Matters Level 2 HORMONES WEBINAR Challenging Menopause Case GUIDE Steroid Hormone Testing Guide BLOG Guide for Interpreting Testing Levels for Contraceptive Users BLOG The Pg/E2 Ratio NEUROTRANSMITTERS Neurotransmitter Testing Patient Handout & Quiz WEBINAR Case Review on the Importance of Testing Neurotransmitter Metabolites BLOG When to Test Neurotransmitters with Sex Hormones HEAVY METALS & NUTRIENTS Iodine Deficiency Handout WEBINAR Toxic Heavy Metals & Risks for Cancer BLOG Flaws in the Iodine Loading Dose Urine Test Find these resources and more at zrtlab.com/resources 8 EDUCATIONAL RESOURCES

10 Patients The ZRT Resource Library zrtlab.com/resources offers a wealth of educational options suitable for patients. These resources are all freely available for view or download 24x7x365. Our recommendations include: HORMONES WEBINAR Three-Legged Stool of Hormone Balance WEBINAR Everything You Wanted to Know About Menopause GUIDE Menopause & Your Health STRESS & SLEEP WEBINAR The Truth About Sleepless Nights WEBINAR The Thyroid / Adrenal Connection GUIDE Stress & Hormone Balance WEIGHT WEBINAR The Hidden Truth About Weight Gain WEBINAR Five Factors That Sabotage Weight Loss BLOG Does Hormone Imbalance Contribute to Weight Gain? FERTILITY WEBINAR Mapping the Menstrual Cycle BLOG Menstrual Cycle Mapping Your Questions Answered BLOG Struggling with Fertility? What Hormones to Test. NEUROTRANSMITTERS WEBINAR Is the Neurotransmitter Test Right for You? BLOG Testing Neurotransmitters? Avoid the Big Five. BLOG A Dynamic Duo: When to Test Neurotransmitters with Sex Hormones HEAVY METALS & NUTRIENTS WEBINAR Living with Toxic Metals BLOG Does Bioaccumulation of Toxic Elements Lead to Large Problems? BLOG How 5 Elements Can Affect Your Thyroid Hormones Free Patient Education Literature ZRT offers a variety of patient brochures and handouts that are free to health care providers. You can find an order form at zrtlab.com/resources. You can also contact our customer service team at or info@zrtlab.com to learn more. HORMONE BALANCE Your Key To Better Health NEURO TRANSMITTERS Anxiety & depression can Neurotransmitter Balance Chemical Messengers are Key to Optimal Health SLEEP BALANCE Uncovering the Truth About Sleepless Nights occur when neurotransmitter levels are out of balance. Simple home test kit EDUCATIONAL RESOURCES 9

11 EASE OF WORKING WITH ZRT You re already busy running your practice, so we ve designed our services to keep things simple. myzrt Secure Online Access After logging into the secure, online portal at providers can manage many aspects of their ZRT account such as: Ordering kits Checking on the status of samples Downloading completed reports Live Customer Service Agents Our Customer Service staff are available to assist you Monday Friday, from 6am-5pm PT. Reach us at or or zrtlab.com Online Resources Many educational and patient support documents are located on our company website, such as: Collection Videos zrtlab.com/sample-collection/ Downloadable Instructions zrtlab.com/sample-collection/ Provider & Patient Education zrtlab.com/resources/ Frequently Asked Questions zrtlab.com/faq/ ZRT also posts educational updates and links to useful resources such as: Recent provider webinars New educational patient materials New testing options 10 WORKING WITH ZRT

12 Billing Practices Your account has already been established at ZRT, but our Customer Service team will be happy to answer questions or review your billing options if you want to make adjustments. ZRT s billing options are listed below. Contact us at info@zrtlab.com or or for questions about your account. Bill Provider (Domestic and Canada) Provider distributes kits to patients Provider is billed twice monthly for any report that has been completed Automatic payment methods are available for provider convenience (required in Canada) Patient insurance billing is the responsibility of the provider (except Medicare, see below) Return shipping included Patient Pay (Domestic Only) Provider distributes kits to patients Patient is responsible for payment to ZRT Laboratory We will courtesy bill a select group of insurances as a non-contracted provider at ZRT RETAIL price Return shipping included International Provider distributes kits to patients Provider is billed twice monthly for any report that has been completed (Patient Pay not available) Automatic payment required with this option International shipping charges apply for outbound orders Patient is responsible for return shipping costs Insurance Billing ZRT s saliva testing is generally not covered by insurance, so ZRT does not courtesy bill for those tests. ZRT Laboratory will courtesy bill a limited number of insurance companies as a non-contracted provider at the ZRT retail price. Health care providers must have a Patient Pay account to qualify. See above for detail. Companies billed by ZRT include: Original Medicare Part B, Medicare Advantage Plans, TRICARE, Cigna, Humana and Regence Blue Cross Blue Shield. Please note we do not file secondary insurance. We recommend patients check with their insurance companies regarding coverage prior to testing. Medicare ZRT s saliva testing is not covered by Medicare. ZRT will courtesy bill Medicare for blood and urine testing for all payment options. Health care providers who are PECOS enrolled and wish to use Medicare kits must order specially marked kits from ZRT. Contact us at info@zrtlab.com or or for assistance. BILLING PRACTICES 11

13 Overview of Kits ZRT Laboratory Standard Kits BLOOD + URINE Comprehensive Thyroid Profile Dried Urine: I, Se, Br, Li, As, Cd, Hg, Crtn Blood Spot: T4, Tgbn, TSH, ft3, ft4, TPOab Comprehensive Metals & Nutrients Profile Dried Urine: I, Se, Br, Li, As, Cd, Hg, Crtn Blood Spot: Hg, Cd, Pb, Zn, Cu, Se, Mg DRIED BLOOD SPOT Essential Thyroid Profile TSH, ft3, ft4, TPOab Female Blood Profile I E2, Pg, T, SHBG, DS, C Female Blood Profile II E2, Pg, T, SHBG, DS, C, TSH, ft3, ft4, TPOab Male Blood Profile I E2, T, PSA, SHBG, DS, C Male Blood Profile II E2, T, PSA, SHBG, DS, C, TSH, ft3, ft4, TPOab Hormone Trio: E2, Pg, T Vitamin D 25-OH, Total: D2, D3 CardioMetabolic Profile In, hscrp, HbA1c, TG, CH, HDL, LDL, VLDL Metals & Nutrients - Blood Profile Hg, Cd, Pb, Zn, Cu, Se, Mg SALIVA Female / Male Saliva Profile I: E2, Pg, T, DS, C Female / Male Saliva Profile II: E2, Pg, T, DS, Cx2 Female / Male Saliva Profile III: E2, Pg, T, DS, Cx4 Hormone Trio: E2, Pg, T Adrenal Stress: DS, Cx4 Diurnal Cortisol: Cx4 SALIVA + BLOOD Comprehensive Female Profile I Saliva: E2, Pg, T, DS, Cx4 Blood Spot: TSH, ft3, ft4, TPOab Comprehensive Female Profile II Saliva: Cx4 Blood Spot: E2, Pg, T, SHBG, DS, TSH, ft3, ft4, TPOab Comprehensive Male Profile I Saliva: E2, T, DS, Cx4 Blood Spot: PSA, TSH, ft3, ft4, TPOab Comprehensive Male Profile II Saliva: Cx4 Blood Spot: E2, T, SHBG, PSA, DS, TSH, ft3, ft4, TPOab 12 OVERVIEW OF KITS

14 ZRT Laboratory Specialty Kits ADRENAL STRESS Saliva: DS, Cx4 BLOOD DRAW Female Serum Profile E2, Pg, T, SHBG, DS, C, TSH, ft3, ft4, TPOab Male Serum Profile E2, T, PSA, SHBG, DS, C, TSH, ft3, ft4, TPOab CORTISOL AWAKENING RESPONSE Saliva: DS, Cx6 FERTILITY Saliva: Cx4 Blood Spot: E2, Pg, T, SHBG, DS, TSH, ft3, ft4, TPOab, FSH, LH HEAVY METALS & NUTRIENTS Iodine Panel Metals & Nutrients - Urine Profile Metals & Nutrients - Blood Profile Comprehensive Metals & Nutrients Profile Comprehensive Thyroid Profile MENSTRUAL CYCLE MAPPING Dried Urine: E1G, PDG, LH, Crtn NEUROTRANSMITTERS NeuroAdvanced Profile Dried Urine: GABA, Glu, Gly, DA, Epi, NE, HIST, 5-HT, PEA, DOPAC, HVA, 5-HIAA, NMN, VMA, Crtn SLEEP BALANCE Dried Urine: Melatonin (MT6s) x4, Free Cortisol x4, Free Cortisone x4, Crtn URINE METABOLITES Adrenal Profile Estrogen Essential Profile Estrogen Elite Profile Basic Metabolites Profile Advanced Metabolites Profile WEIGHT MANAGEMENT Saliva: E2, Pg, T, DS, Cx4 Blood Spot: TSH, D2, D3, HbA1c, In ZRT Laboratory Test Kits Our all-inclusive test kits are simple and convenient for both patients and providers. All kits (except serum) are designed for private sample collection at home, at the optimal time. Orders can be placed online at myzrt.com or by phone at or OVERVIEW OF KITS 13

15 TESTS Directory of Tests & CPT CODES *Female/Male Saliva Profile I E2, Pg, T, DS & C 82670, 84144, 84402, 82627, *Female/Male Saliva Profile II E2, Pg, T, DS & Cx , 84144, 84402, 82627, *Female/Male Saliva Profile III E2, Pg, T, DS & Cx , 84144, 84402, 82627, *Hormone Trio - Saliva E2, Pg, T 82670, 84144, *Diurnal Cortisol Cx Blood Spot Profiles Female Blood Profile I E2, Pg, T, SHBG, DS, C 82670, 84144, 84403, 84270, 82627, Female Blood Profile II E2, Pg, T, SHBG, DS, C, TSH, ft3, ft4, TPOab 82670, 84144, 84403, 84270, 82627, 82533, 84443, 84481, 84439, Male Blood Profile I E2, T, PSA, SHBG, DS, C 82670, 84403, 84153, 84270, 82627, Male Blood Profile II E2, T, PSA, SHBG, DS, C, TSH, ft3, ft4, TPOab 82670, 84403, 84153, 84270, 82627, 82533, 84443, 84481, 84439, Hormone Trio - Blood E2, Pg, T 82670, 84144, Combination Profiles Comprehensive Female Profile I Saliva: E2, Pg, T, DS & Cx4 Blood Spot: TSH, ft3, ft4, TPOab Comprehensive Female Profile II Saliva: Cx4 Blood Spot: E2, Pg, T, SHBG, DS, TSH, ft3, ft4, TPOab Comprehensive Male Profile I Saliva: E2, T, DS, Cx4 Blood Spot: PSA, TSH, ft3, ft4, TPOab Comprehensive Male Profile II Saliva: Cx4 Blood Spot: E2, T, PSA, SHBG, DS, TSH, ft3, ft4, TPOab Thyroid Profiles Comprehensive Thyroid Profile Blood Spot: T4, Tgbn, TSH, ft3, ft4,tpoab Dried Urine: I, Se, Br, Li, As, Cd, Hg, Crtn 82670, 84144, 84402, 82627, 82530, 84443, 84481, 84439, , 82670, 84144, 84403, 84270, 82627, 84443, 84481, 84439, , 84402, 82627, 82530, 84153, 84443, 84481, 84439, , 82670, 84403, 82627, 84270, 84153, 84443, 84481, 84439, , 84432, 84443, 84481, 84439, 86376, 84311, 84255, 84311, 80178, 82175, 82300, 83825, Essential Thyroid Profile Blood Spot: TSH, ft3, ft4, TPOab 84443, 84481, 84439, Heavy Metals & Nutrients Profiles Comprehensive Metals & Nutrients Profile Dried Urine: I, Se, Br, Li, As, Cd, Hg, Crtn Blood Spot: Hg, Cd, Pb, Zn, Cu, Se, Mg Metals & Nutrients - Blood Profile Blood Spot: Hg, Cd, Pb, Zn, Cu, Se, Mg Metals & Nutrients - Urine Profile Dried Urine: I, Se, Br, Li, As, Cd, Hg, Crtn Specialty Profiles *Adrenal Stress Profile Saliva: DS, Cx , *Cortisol Awakening Response Profile Saliva: DS, Cx , , 84255, 84311, 80178, 82175, 82300, 83825, 82570, 83825, 82300, 83655, 84630, 82525, 84255, , 82300, 83655, 84630, 82525, 84255, , 84255, 84311, 80178, 82175, 82300, 83825, CardioMetabolic Profile Blood Spot: In, hscrp, HbA1c, TG, CH, HDL, LDL, VLDL 83525, 86141, 83036, 84478, 82465, Fertility Profile Saliva: Cx4 Blood Spot: E2, Pg, T, SHBG, DS, TSH, ft3, ft4, TPOab, FSH, LH 82530, 82670, 84144, 84403, 84270, 82627, 84443, 84481, 84439, 86376, 83001, Menstrual Cycle Mapping Dried Urine: E1G, PDG, LH, Crtn 82679, 84135, 83002, Sleep Balance Profile Dried Urine: Melatonin (MT6s) x 4, Free Cortisol x 4, Free Cortisone x 4, Crtn Add-on Diurnal Norepinephrine & Epinephrine Dried Urine: NE x 4, Epi x , Weight Management Profile Saliva: E2, Pg, T, DS, Cx4 Blood Spot: TSH, D2, D3, In, HbA1c 82542, 82530, 82530, , 84144, 84402, 82627, 82530, 84443, 82306, 83525, Add-on Thyroid Blood Spot: ft3, ft4, TPOab 84481, 84439, Add-on Cardio Blood Spot: hscrp, TG, CH, LDL, VLDL, HDL 86141, 84478, 82465, DIRECTORY OF TESTS & CPT CODES

16 Neurotransmitter Profiles NeuroAdvanced Profile Dried Urine: GABA, Glu, Gly, DA, Epi, NE, HIST, 5-HT, PEA, DOPAC, HVA, 5-HIAA, NMN, VMA, Crtn Include any of the following Add-ons with the above profile: 82136, 82136, 82136, 82384, 82384, 82384, 83088, 84260, 82136, 82384, 83150, 83497, 83835, 84585, Saliva Hormones E2, Pg, T, DS, C 82670, 84144, 84402, 82627, Urine Hormones Dried Urine: E2, Pregnanediol, Allopregnanolone, Androstenedione, T, Epi-T, DHT, DHEA, 5α,3α-Androstanediol 82670, 84135, 84140, 82157, 84403, 82542, 82542, 82626, Diurnal Cortisol Dried Urine: Free Cortisol x 4, Free Cortisone x , Diurnal Cortisol & Melatonin Dried Urine: Free Cortisol x 4, Free Cortisone x 4, Melatonin (MT6s) x 4 Diurnal Cortisol, Norepinephrine & Epinephrine Dried Urine: Free Cortisol x 4, Free Cortisone x 4, NE x 4, Epi x 4 Diurnal Cortisol, Melatonin, Norepinephrine & Epinephrine Dried Urine: Free Cortisol x 4, Free Cortisone x 4, Melatonin (MT6s) x 4, NE x 4, Epi x 4 Urine Metals & Nutrients Dried Urine: I, Se, Br, Li, As, Cd, Hg Hormone Metabolites Profiles Adrenal Profile Dried Urine: Androgens (1), Glucocorticoids (4), Free Cortisol (4), Free Cortisone (4), Crtn Single Tests in Saliva (price per test) *Cortisol (C) *DHEA-S (DS), *Estradiol (E2), Estrone (E1), Estriol (E3), *Progesterone (Pg), *Testosterone (T) Single Tests in Blood Spot (price per test) Cortisol (C) or DHEA-S, Estradiol (E2, total), Progesterone (Pg, total), Testosterone (T, total), Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH) 82530, 82530, , 82530, 82384, , 82530, 82542, 82384, , 84255, 84311, 80178, 82175, 82300, 83825, , 82533, 83491, 82530, Estrogen Essential Profile Dried Urine: Estrogens (12), Crtn 82670, 82679, 82677, Estrogen Elite Profile Dried Urine: Estrogens (13), Progestogens (2), Androgens (5), Crtn Basic Metabolites Profile Dried Urine: Estrogens (3), Progestogens (2), Androgens (5), Glucocorticoids (1), Crtn Advanced Metabolites Profile Dried Urine: Estrogens (13), Progestogens (7), Androgens (8), Glucocorticoids (4), Free Cortisol (4), Free Cortisone (4), Melatonin (MT6s) (4), Crtn Seurm Profiles Female Serum Profile E2, Pg, T, SHBG, DS, C, TSH, ft3, ft4, TPOab Male Serum Profile E2, T, PSA, SHBG, DS, C, TSH, ft3, ft4, TPOab 82670, 82679, 82677, 82542, 84135, 84140, 82626, 82157, 84403, , 82679, 82677, 84135, 84140, 82626, 84403, 82542, 82533, , 82679, 82677, 84135, 84140, 84144, 83498, 82633, 82528, 82626, 82157, 82160, 82696, 84403, 82530, 82533, 83491, 82542, , 84144, 84403, 84270, 82627, 82533, 84443, 84481, 84439, , 84403, 84153, 84270, 82627, 82533, 84443, 84481, 84439, , 82670, 82679, 82677, 84144, , 82627, 82670, 84144, 84403, 83001, Hemoglobin A1c (HbA1c), High Sensitivity C-Reactive Protein (hscrp), Prostate Specific Antigen (PSA), Triglycerides (TG) 83036, 86141, 84153, Free Triiodothyronine (ft3), Free Thyroxine (ft4), Total Thyroxine (T4), Thyroid Stimulating Hormone (TSH), Thyroid Peroxidase Antibody (TPOab), Thyroglobulin (Tgbn) Insulin (In), Insulin-Like Growth Factor I (IGF-1), Sex Hormone Binding Globulin (SHBG) *Vitamin D 25-OH, Total (D2, D3) Single Tests in Dried Urine 84481, 84439, 84436, 84443, 86376, , 84305, Iodine Panel Iodine (I), Creatinine (Crtn) 84311, Only tests marked with an asterisk (*) are available to NY residents. DIRECTORY OF TESTS & CPT CODES 15

17 GENERAL INFORMATION Mailing Address ZRT Laboratory 8605 SW Creekside Place Beaverton, OR Contact Info Telephone: Toll-free: Fax: Website: The American Medical Association s Current Procedural Terminology (CPT ) codes in ZRT Laboratory s Test Directory are provided for informational purposes only. CPT codes are provided only as a guide to assist providers with billing. ZRT recommends that clients confirm CPT codes with their Medicare administrative contractor, as requirements may differ. CPT coding is the sole responsibility of the billing party. ZRT assumes no responsibility for billing errors due to reliance on the published CPT codes. Health Insurance Portability & Accountability Act (HIPAA) ZRT Laboratory is committed to complying with privacy and security standards outlined in the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act. Notice of Privacy Practices may be found at Clinical Research & Study Testing Please contact us to inquire about research testing at GENERAL INFORMATION

18 Revised ZRT Laboratory is a CLIA certified diagnostic laboratory that supports health care professionals in health management through accurate, convenient and innovative lab testing.