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Specimen Labeling/Request Form Completion

Collection Procedure:



Policy Tech: Version: 4


Purpose:The purpose of this policy is to describe the process of labeling laboratory
specimens and proper completion of laboratory requisition/script.


It is the responsibility of staff to properly label all laboratory specimens. It is the
requirement of the Akron Children’s Enterprise as specified when sending
specimens to any laboratories operated by Akron Children’s Hospital to follow the
guidelines for labeling all specimens:

Applies to: Akron Children's Hospital Enterprise


All specimens must be labeled at the side of the patient prior to leaving the
room. All specimens coming into the laboratory are required to be labeled as
stated in the guidelines.
All specimens sent to the laboratory must be accompanied by a requisition/audit
slip which contains the same two patient identifiers used to identify the patient
and the information as detailed in the section of the request form. (Labels from
the lab system may substitute for a requisition as they contain all pertinent

Blood Bank Specific Information - When ordering through EPIC, the required

patient and transfusion history must be completed by the APP. If ordering

outside of EPIC, as always a manual Blood Bank Requisition must be completed

which includes the history sections mentioned above. In either case a completed

Blood Bank requisition is required to include the signature of the APP ordering

the test. In addition at the time of specimen collection the two signatures

(collector and witness) verifying the identification of the patient should be placed

on the Blood Bank requisition.


1. Two patient identifiers from the identification band or provided verbally if

no band is present and from the order (script, request form, audit, order

labels) must be compared at the time of collection.

2. After collecting the specimen and before leaving the patient

room/bedside, label each collection tube/container, using a patient label

generated by the hospital or laboratory system or handwritten. The label

must minimally contain two patient identifiers (patient’s full name and

medical record number and/or date of birth), date of collection and

collectors employee number. In case of unidentified patients, label

should contain assigned patient name at time of collection and both the

medical record and account numbers. Room number and bed are not

acceptable identifiers!

Specimen Labeling/Request Form Completion, Version # 4, Minor Revision 02/12/13

3. The phlebotomist is identified by placing the employee number on the

specimen container. This will then be entered into the LIS at accessioning

to become part of the permanent record.

4. Special circumstances require the following additional information on the


a. Specimens sent with an audit slip or laboratory requisition.

1. Time of collection when specimen is for Blood Bank or one

drawn in a series; e.g. Glucose Tolerance or Stimulation


2. The employee number of the individual collecting the

specimen must be on all Blood Bank specimens.

b. Specimens sent with no paperwork (Not applicable to Blood Bank);

e.g. script or lab labels only

1. Specimen Collector ID – hospital employee number (initials if

not an employee). (In a trauma situation an alternate staff member

who has verified the two patient identifiers may write the employee

number of the individual who drew the blood and add their own


2. Time of collection

3. Source

Blood – capillary or venous

Urine – cath or clean catch

Swab – throat, NPH, leg (location of where swab was taken)

5. Transport – When picking up a newborn and the referring hospital is

sending mother’s blood, the mother’s blood must be labeled with her full

name, date of birth, the date of the draw, and the initials or signature of

the person drawing the blood. A completed ‘Transport Form to

Accompany Mother’s Blood’ must be sent to the lab with the specimen.

Request Form:

1. All requests for Blood Bank Testing must be submitted on a double

signed Blood Bank requisition (Epic or manual). The requisition must

be completed and signed by the ordering APP. The patient history and

transfusion history sections are critical to patient safety. Any departments

‘live’ on EPIC must place Blood Bank orders in EPIC .The manual

requisition is also required for campus’s other than Akron that are

collecting Blood Bank samples to be sent to Akron campus.

2. For Inpatient areas using audit trails, complete the blanks requesting

collection time, employee ID, and source – capillary, venous, arterial.

3. For Inpatient/Outpatient areas sending a request form/requisition

(other than an audit trail) which accompanies an already drawn specimen,

the following information should be on the request form:

Specimen Labeling/Request Form Completion, Version # 4, Minor Revision 02/12/13

a. Patient Information

1. Two patient identifiers which were used to identify the patient

– name and date of birth/medical record number. If patient

name is ‘unknown’ use Medical Record and CSN Number.

2. Sex – male or female

3. Clinical information when appropriate – e.g. Patient History

for Genetic testing, Time of dose of medication for drug level

(peak or trough), etc.

b. Specimen Information

1. Collection date and time

2. Source e.g. urine, wound, NPH

3. Descriptive information, e.g. left or right, clean catch or

catheter, peak or trough, capillary, venous, or arterial,

pertinent to the report.

4. Tests requested

c. Physician Information

1. Full name and for outpatients the National Provider

Identification number (NPI)

d. Report Routing Information

1. Inpatients – Patient location where report should be sent.

2. Outpatients – Physician’s address/location

4. Transport – When transporting a newborn and delivering mother’s blood

to ACH lab the form titled ‘Transport Form to Accompany Mother’s Blood

must accompany the mother’s blood to the lab. In addition the baby’s

label will be placed on the mother’s blood in such a manner that both may

be read.

5. For outpatient physicians sending a script requesting laboratory

testing, the following information must be provided.

a. Patient Information

1. Name and date of birth

2. Clinical information when appropriate – e.g. Patient History

for genetic testing, time of dose of medication, etc.

3. ICD-9 code and/or diagnosis.

b. Specimen Information

1. Order date and time

2. Tests requested

3. Specific information, i.e. clean catch or catheter for a urine


c. Physician Information

1. Full name and for outpatients the National Provider

identification number (NPI) for non-Akron Children’s


d. Routing Information

1. Inpatients – Patient Unit

2. Outpatients – Physician’s address/location

Specimen Labeling/Request Form Completion, Version # 4, Minor Revision 02/12/13

Blood Bank Disclaimer:

. Mislabeled Blood Bank specimens will not be processed, regardless

of the situation. This includes any mismatched or missing

information involving the specimen and/or the Blood Bank

requisition. All mislabeled Blood Bank specimens will be redrawn.