Acid Fast Culture

Infectious Disease Laboratories : Microbiology

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. Acid Fast Culture
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Test ID/Workstation :

TBC/S SUMMA

Specimen Type:

Sputum, BAL, Gastric aspirate, Urine, Tissue, CSF, Blood or Bone Marrow, Stool, Throat swab (ESwab) if unable to obtain sputum

Tube Type:

Specimen container, Isolator tube (blood or bone marrow)

Collection Volume:

Sputum:5-10 mL Blood or Bone Marrow: 1.5 mL in Isolator tube Gastric asp.: 5.0 mL or greater Urine: First void 25-50 mL BAL: 1.0 mL or greater

Cause for Rejection:

Specimen sent in nonsterile container. Sputum specimen consisting of all saliva. Specimens with insufficient volume will be rejected.

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Fluorescent Antibody Stain for AFB, Culture for AFB

Special Instructions:

For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly)

Lab/Phone:

330-543-8412

TAT:

AFB stain: 24 hours; AFB culture: 8 weeks

Additional Info:

Physician will be notified of positive stains and/or cultures

CPT Code:

87116

Synonyms:

Mycobacterial Culture; AFB Culture; TB Culture

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Acid Fast Culture

Infectious Disease Laboratories : Microbiology

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