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. Parainfluenza Isol.   
2.   
3.   
4.   
5.   
6.   

SPECIMEN INFO
Collection Date & Time:
Collected By:
Test Information for Parainfluenza Isol.
CPT Code: 87254

Specimen Type: Throat/NPH swabs, nasal washings, sputum in M4M

Tube Type/Collection Container: Specimen container

Collection Volume: 1.5 mL aspirate or inoculated M4M

Cause for rejection: Specimen dry, fixed or not in proper transport media

Storage: Refrigerated

Availability: Daily (0800-1700)

Methodology: SVC - Typing by IFA for parainfluenza 1, 2, + 3

Special Instructions: Deliver immediately on ice to lab. POP: Keep cold, deliver ASAP. Extract swab specimens thoroughly into M4M. Press swab against inside of vial, then discard swab. M4M available from Micro/Viro Lab or CCL. Nasal/tracheal washes are specimens of choice for respiratory viral isolation.

TAT: 48-72 hours


Lab/Phone: 330-543-8576

Additional Info: Reference range: No parainfluenza virus isolated

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: