Gram Stain Vaginal

Infectious Disease Laboratories - : Microbiology

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. Gram Stain Vaginal
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

GRAMV

Test Workstation :

MIC1

Specimen Type:

Vaginal Eswab or Vaginal washing in sterile container.

Minimum Volume:

Vaginal washing minimum volume is 0.2 mL.

Cause for Rejection:

Quantity not sufficient, improper specimen type, improper storage/transport, improper swab, dry swab, swab not present, multiple swabs per vial, mislabeled, or unlabeled.

Storage:

Transport at room temperature. Upon arrival in laboratory, store refrigerated.

Availability:

Mon-Sun (0700-1600)

Methodology:

Microscopic Examination

Lab/Phone:

330-543-8406

TAT:

24 hours

CPT Code:

87205

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Gram Stain Vaginal

Infectious Disease Laboratories - : Microbiology

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