Bone Marrow
| 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. Bone Marrow | |
| 2. | |
| 3. | |
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| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
BNMRW
Test Workstation :
SPHEM
Specimen Type:
Bone Marrow Aspirate and/or Biopsy
Tube Type:
Specimen container
Collection Volume:
See Special Instructions
Cause for Rejection:
Dry Tap"; clotted specimen"
Storage:
Ambient
Availability:
Mon-Fri (0800-1530); Sat-Sun (1000-1400)
Methodology:
Microscopic evaluation of Wright's stained coverslip preparation
Special Instructions:
Hem Onc Physician must schedule procedure with CCL (x38416), indicating any cultures, biopsy, chromosome studies, immunological tests or other special orders. Nursing station must call CCL when the physician arrives to perform the procedure.Must fill out appropriate testing requisition
Lab/Phone:
330-543-8416
TAT:
48-72 hours
Additional Info:
Reference range is available on patient report
CPT Code:
-
Synonyms:
Bone Marrow Aspirate; Bone Marrow Biopsy
