Department of Pathology
and Laboratory Medicine

Akron Children's Hospital
One Perkins Square
Akron, OH 44308
Laboratory
Ph: (330) 543-8573
Fax: (330) 543-3659

LABORATORY TEST REQUISITION


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. Enteric Culture   
2.   
3.   
4.   
5.   
6.   

SPECIMEN INFO
Collection Date & Time:
Collected By:
Test Information for Enteric Culture
CPT Code: 87045,87899 x2

Specimen Type: Fresh whole stool, Rectal swab

Tube Type/Collection Container: Stool container, or Rectal swab in Eswab transport tube

Collection Volume: Whole stool (minimum - swab)

Cause for rejection: Whole stool specimen contaminated with urine or water or containing barium. Specimens sent to laboratory in diaper, or on wooden stick/tongue depressor,rectal swab not in transport tube or dried stool will be rejected.

Storage: Refrigerated

Availability: Daily

Methodology: Culture

Special Instructions: Send whole fresh stool or rectal swab collected using Eswab may be taken if patient cannot produce stool. Enteric culture screens primarily for Salmonella, Shigella, Campylobacter and Shiga toxins 1&2 (which includes Ecoli 0157:H7 and other non-0157 STEC serogroups). If physician orders stool screened for Yesinia Vibrio, these cultures are ordered separately and in addition to Enteric culture. Stool cultures should not be performed on patients after 3 days in the hospital because the isolation of stool pathogens is very low, consistent with the epidemiology of acute bacterial diarrhea.

TAT: 72 hours


Lab/Phone: 330-543-8412

Additional Info: Preliminary report available after 24 hours

Transport specimens to processing area of the laboratory in an appropriate container. Additional information is available from Cindy Maurer at (330)543-8689.

SHIP TO:
Department of Pathology and Laboratory Medicine
CCL
Akron Children's Hospital
One Perkins Square
Akron, OH 44308


Physician Signature: Date: