Cytomegalovirus (CMV), Newborn Screen, Qualitative PCR Assay

Molecular Diagnostics - : DNA

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. Cytomegalovirus (CMV), Newborn Screen, Qualitative PCR Assay
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

LAB4526/CMVNE

Test Workstation :

DNA2

Specimen Type:

0.5 mL urine collected in sterile container.

Minimum Volume:

Specimen minimum volume is 0.2 mL.

Cause for Rejection:

Quantity not sufficient, improper specimen type, improper storage/transport, mislabeled, or unlabeled.

Storage:

Refrigerated

Availability:

Mon-Fri (7:30-16:00)

Methodology:

Real-time Polymerase Chain Reaction

Special Instructions:

Testing for patients <= 4 weeks of age ONLY.

Lab/Phone:

330-543-8722

TAT:

1-3 days

CPT Code:

87496

Synonyms:

CMV PCR Cytomegalovirus PCR

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Cytomegalovirus (CMV), Newborn Screen, Qualitative PCR Assay

Molecular Diagnostics - : DNA

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