Group B Strep Culture
| 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. Group B Strep Culture | |
| 2. | |
| 3. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
GRBSC
Test Workstation :
MIC2
Specimen Type:
Eswab collected from vaginal-rectal source.
Cause for Rejection:
Improper specimen type, improper storage/transport, improper swab, dry swab, swab not present, multiple swabs per vial, mislabeled, or unlabeled.
Storage:
Ambient
Availability:
Mon-Sun
Methodology:
Culture
Special Instructions:
Please note if patient has an allergy to Penicillin. Collect specimen from both areas and place in same Eswab transport tube to maximize recovery of Group B Strep.
Lab/Phone:
330-543-8406
TAT:
72 hours
CPT Code:
87081
Synonyms:
Group B Strep Screen
