Gram Stain
| PATIENT INFO |
| Patient Name: |
| Medical Record #: |
| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
| Address: |
| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
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| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. Gram Stain | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
LAB250
Specimen Type:
E-swab; Tissue; Body fluid
Cause for Rejection:
Quantity not sufficient, improper specimen type, improper storage/transport, improper swab, dry swab, multiple swabs per vial, mislabeled, or unlabeled.
Storage:
Refer to storage conditions for related cultures.
Availability:
Monday thru Sunday (08:00 - 22:00)
Methodology:
Microscopic examination
Lab/Phone:
330-543-8406
TAT:
24 hours
Additional Info:
Gram stains are automatically performed for all CSF, Aerobic, Wound, Sputum, Respiratory (excluding oropharyngeal sites), and Tracheal Aspirate Cultures and do not need to be ordered separately.
For vaginal sources, please order the Gram Stain, Vaginal order (LAB4167).
For vaginal sources, please order the Gram Stain, Vaginal order (LAB4167).
CPT Code:
87205
Synonyms:
Bacterial Stain; Direct Stain for Bacteria
