Adenovirus, Qualitative PCR

Molecular Diagnostics - : DNA

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. Adenovirus, Qualitative PCR
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

LAB3001/ADNPC

Test Workstation :

DNA2

Specimen Type:

2 mL blood collected in one EDTA (purple top) tube.
One flocked swab in 3.0 mL M4 Viral Transport Medium collected from nasopharyngeal, throat, eye, or lesion source.
2.0 mL bronchoalveolar lavage (BAL), bronchial wash, nasal wash, or tracheal aspirate collected in sterile container.
0.5 mL amniotic fluid, body fluid, cerebrospinal fluid (CSF), or urine collected in sterile container.
250mg (pea sized amount) of soft stool or 0.5 mL liquid stool in sterile container.

Minimum Volume:

Blood minimum volume is 0.5 mL.
Amniotic fluid, body fluid, CSF, or urine minimum volume is 0.2 mL.
BAL, bronchial wash, nasal wash, and tracheal aspirate minimum volume is 1.2 mL.
Minimum 125 mg (half pea size amount) of stool or 0.2 mL liquid stool.

Cause for Rejection:

Quantity not sufficient, specimen clotted, improper anticoagulant, improper specimen type, improper storage/transport, improper swab, dry swab, swab not present in M4 VTM vial, multiple swabs per vial of M4 VTM, mislabeled, or unlabeled.

Storage:

Refrigerated

Availability:

Mon-Fri (7:30-16:00)

Methodology:

Real-time Polymerase Chain Reaction

Lab/Phone:

330-543-8722

TAT:

1-3 days

CPT Code:

87798

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Adenovirus, Qualitative PCR

Molecular Diagnostics - : DNA

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