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:

Test ID/Workstation :

HSDNC / VIR3

Specimen Type:

CSF

Tube Type:

Sterile Container

Collection Volume:

0.2 mL (minimum 150uL)

Cause for Rejection:

Specimen clotted with no liquid and QNS

Storage:

Refrigerated

Availability:

Daily

Methodology:

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

Special Instructions:

Testing performed same day if received in laboratory by 2:00 p.m. Saturday/Sunday - same day if received in laboratory by 11:00 a.m. For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly).

Lab/Phone:

330-543-8576

TAT:

3 hours

Additional Info:

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

CPT Code:

87529

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HSV PCR, CSF

Infectious Disease Laboratories : Virology

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