Chlamydia pneumoniae PCR

- : 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 pneumoniae PCR
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

CPNPC

Test Workstation :

CLEVE

Specimen Type:

Respiratory specimen

Tube Type:

Sterile container

Collection Volume:

2.0 mL (minimum 0.5 mL)

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Polymerase Chain Reaction (PCR)

Special Instructions:

Bronchial lavage or respiratory swab in M4 media is also acceptable. Days Performed: SunSat

Lab/Phone:

330-543-8418

TAT:

2-6 days

Additional Info:

Reference range: Not Detected

CPT Code:

87486

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