SOMA MEDICAL SDN BHD (671166-M)

SOMA MEDICAL SDN BHD (671166-M) 92A, LORONG MAAROF, BANGSAR PARK, 59000 KUALA LUMPUR, MALAYSIA TEL: +603-22874790 FAX: +603-22876790

PATIENT’S NAME/ADDRESS REFERRING DOCTOR/CLINIC STAMP/FAX

□ Bill pa*ent □Bill Referring Doctor □Guarantee le4er a4ached

DOB SEX TEL NIRC Date blood taken

Clinical note √:

□ Bronchitis

□ Migraine

□ Food Sensi*vity

□ Allergic Rhini*s

□ Ur*caria

□ Ear problem

□ Family History

□ Asthma

□ Eczema

□ Joint pains

□ Wheezing

□ Conjunc*vi*s

□ Angioedema

□ Diarrhoea

□ Breathlessness

□ Nasal Itching

□ Sneezing

□ Rhinorrhoea

□ Nasal Obstruction

□ Ac*ve smoker

□ Passive smoker

□ Pets ________

□ Fan / Aircond

UniCAP ® RAST IgE MEDIATED TESTS- Price list

(Please tick √ on appropriate box)

Food Allergens

f1 Egg white 70

f2 Cows milk 70

f4 wheat 70

f13 peanut 70

f14 soya bean 70

f25 tomato 70

f45 yeast 70

f48 onion 70

f79 gluten 70

f93 cacao (cocoa) 70

f9 rice 70

f6 barley 70

f8 corn/maize 70

f10 sesame seed 70

f35 potato 70

f36 coconut 70

f47 garlic 70

f75 egg yolk 70

f81 cheddar cheese 140

f235 lentil 80

Rf221 coffee 70

Rf222 tea 70

Rf281 curry 70

f7 oat 70

f31 carrot 70

f202 cashew nut 150

f256 walnut 100

Meat

f88 Mutton 70

f27 beef 70

f83 chicken 70

f26 pork (non-muslim) 70

Seafoods

f3 Fish (cod) 70

f61 sardine pitchard 70

sas indian anchovy (ikan bilis) 150

f23 crab 70

f24 shrimp 70

f58 pacific squid (sotong) 70

f207 clam (kerang) 80

Fruits

f33 orange 70

f87 melon 70

f92 banana 70

f91 mango 70

f44 strawberry 70

f49 apple 70

f210 pineapple 70

f259 grape 70

Specialised tests

Skin prick test (16 Allergens) 480

Contact patch Testing 300

IgG/IgG4 96 food panel 1600

CLA 29 food/aeroallergen IgE panel 720

Serum IgE Antibody Level

Total IgE – child & adult

atopy screening 70

Cord Blood IgE – newborn

cord atopy screening 160

Mixes & Screening

Phadiatop inhalant allergen

screening (contains many

aeroallergens incl. common

grass. Tree pollen, weed,

common moulds, house –

dust mite, cat,dog & others

150

Phadiatop infant (children <

4 years old) (egg white, milk,

peanut, house-dust mite, cat

dander, dog dander, local

pollens)

150

fx 5E common food mix (egg

white, milk, fish, wheat,

peanut & soya)

140

fx 1 Common nut mix

(peanut, brazil nut, hazel nut,

almond, & others)

140

fx 2 seafood mix (fish-cod,

tuna, shrimp, blue mussel,

salmon)

140

fx3 Cereal mix (wheat,

maize, oat, sesame seed,

buckwheat)

140

hx 2 housedust mix (house

dust, house-dust mite D.F.,

house-dust mite D.P.,

cockroach)

140

mx 2 mould mix (Penicillium

N, Candida A, Clasdosprium

H, Alternaria, Aspergillus F,

Helminthosporum H)

140

ex 2 Pet mix (cat dander, dog

dander, guinea pig

epithelium, rat, mouse)

140

ex 72 Feather mix

(budgerigar, canary,

parakeet, parrot, and finch

feathers)

140

Individual Specific Allergen

Testing

House dust mites

d1 D. Pteronyssinus 70

d2 D. Farinae 70

Rd201 B. Tropicalis 140

h2 Hollister Stier Laps 70

Epidermals

e1 cat dander 70

e3 horse dander 70

e5 dog dander 70

e6 guinea pig 70

e81 sheep epithelium 70

e84 hamster 100

e82 rabbit 100

Moulds

m2 Cladosprium herbrum 70

m3 Aspergillus fumigatus 70

Insects

i6 cockroach 70

i71 mosquito 140

Parasites

p1 Ascaris lumbricoides 100

Polles (Malaysia)

Oil Palm pollen 150

Paspalum Notatum (Bahia

Grass) 70

Occupational Allergens

k82 latex 180

Antibiotic Allergy Tests

c1 Penicillin G 150

c2 Penicillin V 150

c5 Ampicillin 150

c6 Amoxycillin 150

Rc7 Cefaclor 150

Anaesthetic Allergy Test

Rc202 Suxamethonium 160

Free blood collection service – within K.L. Tel: 019 – 224

2640, 03 – 2287 4790, 03 – 2287 5790