Cytomegalovirus (CMV), Qualitative PCR
| 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), Qualitative PCR | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
LAB1332
Specimen Type:
Blood (plasma)
Bronchoalveolar lavage (BAL)
Urine
Stool
Bronchoalveolar lavage (BAL)
Urine
Stool
Tube Type:
Blood (plasma): 2 mL collected in a Purple Top- EDTA Tube (1.0 mL whole blood minimum)
BAL: 2.0 mL collected in a Sterile Container (0.3 mL minimum)
Urine: 2.0 mL collected in a Sterile Container (0.3 mL minimum)
Stool: 250mg (pea sized amount) of soft stool or 0.5 mL liquid stool in Sterile Container (125 mg soft stool or 0.3 mL liquid stool minimum)
Cause for Rejection:
Quantity Not Sufficient
Specimen Not Received
Specimen Mislabeled
Specimen Not Labeled
Broken/Spilled in Transport
Hemolyzed
Specimen Clotted
Unacceptable Type or Source Submitted
Wrong Container
Improperly Preserved/Processed
Sample Stored at Incorrect Temperature
Sample Exceeds Holding Time
Storage:
Refrigerated
Availability:
Tuesdays and Fridays
Methodology:
Real-Time Polymerase Chain Reaction
Special Instructions:
Upon arrival in laboratory, promptly centrifuge blood specimen tube and send 1.0 mL of the plasma to the Molecular laboratory. Refrigerate.
Lab/Phone:
330-543-8722
TAT:
1-5 days
Specimens may be run same day for this test if the specimen is received into the Molecular Diagnostics Lab by 8 am on the day(s) of the week this testing is performed.
Specimens may be run same day for this test if the specimen is received into the Molecular Diagnostics Lab by 8 am on the day(s) of the week this testing is performed.
Additional Info:
Hours of Operation: Monday - Friday, 7:30 - 16:00
The Molecular Diagnostics Lab is not open on weekends or holidays.
The Molecular Diagnostics Lab is not open on weekends or holidays.
CPT Code:
87496
Synonyms:
CMV DNA
CMVQL
CMVQL
