Helicobacter Culture
| 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: |
| Ph: ( ) - Fax: ( ) - |
| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. Helicobacter Culture | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
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Test ID :
CLO
Test Workstation :
MIC2
Specimen Type:
Gastric mucosal biopsy or stomach tissue placed in CLO test device immediately after collection.
Cause for Rejection:
Excessive delay in transporting to laboratory. Must be received in laboratory within 72 hours of collection.
Storage:
Ambient
Availability:
Mon-Sun (0700-1600)
Methodology:
Culture
Special Instructions:
Gastric tissue is inserted into test slide by physician at bedside or in surgery. The laboratory will supply test slides to physician upon request. Transport CLO test slide to laboratory immediately. Unused test slides should be stored in refrigerator and allowed to warm to room temperature before use. DO NOT FREEZE TEST SLIDES.
Lab/Phone:
330-543-8406
TAT:
24 hours
Additional Info:
-
CPT Code:
87081
Synonyms:
H. pylori Culture; Gastric Culture for H. pylori
CLO Test
