Chlamydia Culture

Infectious Disease Laboratories : Virology

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. Chlamydia Culture
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

CHLAM VIR1

Specimen Type:

Eye (conjunctiva), Genital added to Viral Transport Medium (M4) acceptable.

Tube Type:

Flocked swab in M4

Collection Volume:

Swab extracted or broken off into viral transport medium (M4)

Cause for Rejection:

Specimen not in viral transport medium (M4), dry, in non-sterile container, QNS

Storage:

Refrigerated

Availability:

Mon, Wed, Fri

Methodology:

Spin-amplified shell vial culture with subsequent IFA stain to confirm

Special Instructions:

Specimens in M4 must be sent on ice immediately to lab. Viral transport medium (M4) available from Virology (ext. 38576) or CCL ( ext. 38417) labs. Urine specimens are NOT acceptable. A negative result does not rule out infection. Positive results called.

Lab/Phone:

330-543-8576

TAT:

2-5 days

Additional Info:

Reference Range: NEGATIVE. No Chlamydia isolated.

CPT Code:

87110

Synonyms:

C. trachomatis isolation

Specimen Collection Procedures:

Conjunctival (Bacterial culture or Chlamydia viral culture of the eye), Genital Specimen Collection

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Chlamydia Culture

Infectious Disease Laboratories : Virology

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