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Cordstat Drug Screen

Laboratory : Chemistry

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. Cordstat Drug Screen
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

CORDD USDTL

Specimen Type:

Umbilical cord tissue

Tube Type:

Kit provided by USDTL Laboratory for specimen and requisition

Collection Volume:

6 inches umbilical cord tissue

Cause for Rejection:

Umbilical cord rinsed with alcohol or fixed with formalin

Storage:

Ambient

Availability:

Sent to Reference Laboratory

Special Instructions:

Sample size is 6 inches of umbilical cord tissue that has been drained, exterior rinsed with saline (NO alcohol product), and patted dry. Umbilical cord is NOT fixed in formalin.

TAT:

2-3 days

Additional Info:

Umbilical cord is stored at room temperature for 7days, can be refrigerated (2-8 degrees C) for up to 3 weeks and frozen (<10 degrees C) up to 1 year.

CPT Code:

80301

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There are 10 nurses in the picture.

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The five differences are:
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– Coat pocket
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– Stethoscope bell dot
– Clipboard paper color

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The two matching doctors are 9 and 14.

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The correct path:

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