Urine 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. Urine Culture | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
URINE
Test Workstation :
MIC2
Specimen Type:
1.0 mL cytoscopic urine, suprapubic urine, catheter collected urine, or clean catch mid-stream urine in sterile container.
Minimum Volume:
Urine minimum volume is 0.1 mL.
Cause for Rejection:
Quantity not sufficient, improper specimen type, improper storage/transport, mislabeled, or unlabeled. Urine specimens > 24 hours. Urine specimens obtained with the same collection method within 48 hours of receipt of first specimen will be rejected as a duplicate specimen.
Storage:
Transport refrigerated required from off campus location. Upon arrival in laboratory, store refrigerated for up to 24 hours.
Availability:
Mon-Sun
Methodology:
Culture
Lab/Phone:
330-543-8406
TAT:
72 hours
CPT Code:
87086
