Blood Smear Review

Centralized Core Laboratory - : Hematology

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. Blood Smear Review
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

BSMRV

Test Workstation :

AHEM1

Specimen Type:

Blood

Tube Type:

Purple top (EDTA) tube: Whole Blood

Collection Volume:

2.0 mL (minimum 0.3 mL) and 2 fresh peripheral blood smears

Cause for Rejection:

Specimens which are hemolyzed, clotted, diluted with IV fluid, or collected in heparin.

Storage:

Refrigerated

Availability:

Daily, 24 hours

Methodology:

Microscopic evaluation of Wright's stained blood film

Lab/Phone:

330-543-8416

TAT:

4 hours

Additional Info:

Reference range is available on patient report

CPT Code:

85007

Synonyms:

Manual Differential; Peripheral smear; WBC morphology

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Blood Smear Review

Centralized Core Laboratory - : Hematology

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