HSV PCR, CSF

Infectious Disease Laboratories - : Virology

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. HSV PCR, CSF
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

HSDNC

Test Workstation :

VIR3

Specimen Type:

0.5 mL cerebrospinal fluid (CSF) in sterile container.

Minimum Volume:

Specimen minimum volume is 0.1 mL.

Cause for Rejection:

Quantity not sufficient, specimen clotted, improper specimen type, improper storage/transport, mislabeled, or unlabeled.

Storage:

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

Availability:

Mon-Sun (0700-1600)

Methodology:

Real-Time FDA-approved Polymerase Chain Reaction (PCR) assay

Lab/Phone:

330-543-4863

TAT:

24 hours

Additional Info:

Testing for CSF only. All other specimen types order HSV PCR (LAB917).

CPT Code:

87529

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HSV PCR, CSF

Infectious Disease Laboratories - : Virology

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