BK Virus, Quantitative PCR
PATIENT INFO |
Patient Name: |
Medical Record #: |
BD: / / Sex: F M |
PHYSICIAN INFO |
Physician Name : |
Address: |
Ph: ( ) - Fax: ( ) - |
Additional Report to: |
Ph: ( ) - Fax: ( ) - |
TESTS REQUESTED | |
Test Name: | ICD9 Code: (required) |
1. BK Virus, Quantitative PCR | |
2. | |
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SPECIMEN INFO |
Collection Date & Time: |
Collected By: |
Hospital: |
Urine
Blood (plasma): 2 mL collected in a Purple Top- EDTA Tube (0.5 mL minimum)
Urine: 2.0 mL collected in a Sterile Container (0.2 mL minimum)
Quantity Not Sufficient
Specimen Not Received
Specimen Mislabeled
Specimen Not Labeled
Broken/Spilled in Transport
Hemolyzed
Specimen Clotted
Unacceptable Type or Source Submitted
Wrong Container
Improperly Preserved/Processed
Sample Stored at Incorrect Temperature
Sample Exceeds Holding Time
BKQN