Fetal Fibronectin (AGMC)

Centralized Core 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. Fetal Fibronectin (AGMC)
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

FFNAG AKRON

Specimen Type:

Vaginal Swab

Tube Type:

Specimen Transport Tube

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Immunochromatographic Assay

Special Instructions:

Care must be taken not to contaminate the swab or cervicovaginal secretions with lubricants, soaps, disinfectants, or creams. Lubricants or creams may physically interfere with absorption of the specimen onto the swab. Soaps or disinfectants may interfere with the antibody-antigen reaction.

Lab/Phone:

330-543-8418

TAT:

1 Day

Additional Info:

Reference range: Negative or Positive

CPT Code:

82731

Synonyms:

-

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