Genital Culture
| 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. Genital Culture | |
| 2. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
GENIT
Test Workstation :
MIC2
Specimen Type:
Eswab collected from genital or urethral source.
Cause for Rejection:
Improper specimen type, improper storage/transport, improper swab, dry swab, swab not present, multiple swabs per vial, mislabeled, or unlabeled.
Storage:
Transport at room temperature and process within 24 hours.
Availability:
Mon-Sun
Methodology:
Culture
Special Instructions:
Do not send vaginal washes.
Lab/Phone:
330-543-8406
TAT:
72 hours
CPT Code:
87070
Synonyms:
Vaginal Culture; Cervical Culture; Urethral Culture
