Gram Stain Vaginal
| PATIENT INFO |
| Patient Name: |
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| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
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| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
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| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. Gram Stain Vaginal | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
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Test ID :
GRAMV
Test Workstation :
MIC1
Specimen Type:
Vaginal Eswab or Vaginal washing in sterile container.
Minimum Volume:
Vaginal washing minimum volume is 0.2 mL.
Cause for Rejection:
Quantity not sufficient, 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. Upon arrival in laboratory, store refrigerated.
Availability:
Mon-Sun (0700-1600)
Methodology:
Microscopic Examination
Lab/Phone:
330-543-8406
TAT:
24 hours
CPT Code:
87205
