Centralized Core Laboratory - Mayo Clinic Laboratories :
Send Out
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/Gonorrhoeae Amplified RNA
2.
3.
4.
5.
6.
SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
CGRNA
Test Workstation :
MAYO
Specimen Type:
Urine
Tube Type:
Sterile Urine Container
Collection Volume:
Refrigerated 20-50 mL random urine in sterile container
Cause for Rejection:
Unlabeled specimen, QNS, contaminated
Storage:
Refrigerated
Availability:
Sent to reference laboratory
Methodology:
Transcription Mediated Amplification
Special Instructions:
Collection Instructions:
1. Patient should not have urinated for at least 1 hour prior to specimen collection.
2. Patient should collect first portion of random voided urine (first part of stream) into a sterile, plastic, preservativefree container.
Lab/Phone:
330-543-8418
TAT:
1-4 days
CPT Code:
87591 and 87491
Panel Includes:
Chlamydia Amplified RNA and Gonorrhoeae Amplified RNA
Chlamydia/Gonorrhoeae Amplified RNA
Test ID/Workstation :
CGRNA
Specimen Type:
Urine
Tube Type:
Sterile Urine Container
Collection Volume:
Refrigerated 20-50 mL random urine in sterile container
Cause for Rejection:
Unlabeled specimen, QNS, contaminated
Storage:
Refrigerated
Availability:
Sent to reference laboratory
Methodology:
Transcription Mediated Amplification
Special Instructions:
Collection Instructions:
1. Patient should not have urinated for at least 1 hour prior to specimen collection.
2. Patient should collect first portion of random voided urine (first part of stream) into a sterile, plastic, preservativefree container.
Lab/Phone:
330-543-8418
TAT:
1-4 days
CPT Code:
87591 and 87491
Panel Includes:
Chlamydia Amplified RNA and Gonorrhoeae Amplified RNA
By using this site, you consent to our use of cookies. To learn more, read our
privacy policy.
