Clostridium difficile by Amplification

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. Clostridium difficile by Amplification
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Test ID/Workstation :

CDIFA MIC2

Specimen Type:

Stool

Tube Type:

Stool Container

Collection Volume:

5.0 mL(minimum 1.0 mL)

Cause for Rejection:

Formed stool, stool specimen sent on swab, diaper, or dried applicator stick, stool sent in viral transport media, stool in Cary-Blair.

Storage:

Refrigerated

Availability:

Daily

Methodology:

DNA Amplification Assy for the detection of cytotoxigenic C. difficile in stool specimen

Lab/Phone:

330-543-8576

TAT:

48 hours

CPT Code:

87493

Synonyms:

Stool for C. diff Toxin, Cl. difficile Toxin Assay, C. difficile

Specimen Collection Procedures:

Stool Specimen Collection

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Clostridium difficile by Amplification

Infectious Disease Laboratories : Virology

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