CMV PCR. Qualitative

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. CMV PCR. Qualitative
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

CMVPC

Test Workstation :

DNA2

Specimen Type:

2 mL blood collected in one EDTA (purple top) tube. 2.0 mL bronchoalveolar lavage (BAL) or bronchial wash 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.
For Congenital CMV, collect 0.5 mL urine 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 and bronchial wash 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, mislabeled, or unlabeled.

Storage:

Refrigerated

Availability:

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

Methodology:

Real-time Polymerase Chain Reaction

Special Instructions:

Upon arrival in laboratory, promptly centrifuge blood specimen tube and send 1.0 mL of the plasma to the Molecular laboratory. Refrigerate.

Lab/Phone:

330-543-8722

TAT:

1-3 days

CPT Code:

87496

Synonyms:

Cytomegalovirus DNA CMV DNA

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CMV PCR. Qualitative

Molecular Diagnostics - : DNA

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