HSV PCR

Molecular Diagnostics : DNA

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
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Test ID/Workstation :

HSVPC DNA2

Specimen Type:

Lesion, Body Fluids, Plasma, Serum, Bronch Wash, Respiratory Specimens, BAL, Amniotic fluid

Tube Type:

Sterile container, purple top (EDTA) tube, Red top (no anticoagulant)tube, or flocked swab in M4

Collection Volume:

0.5 mL

Cause for Rejection:

Clotted specimen; Fluids stored at ambient temperature, QNS

Storage:

Refrigerated

Availability:

Mon-Fri

Methodology:

Real-Time Polymerase Chain Reaction (PCR)

Special Instructions:

Send fluids cold or on ice to lab immediately. Specimens received by 1100 will be processed the same day. CSF specimens- order HSV PCR, CSF (Test Code HSDNA). For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly).

Lab/Phone:

330-543-8722

TAT:

1-3 days

Additional Info:

Reference range: Negative: No HSV 1 or HSV 2 DNA detected.

CPT Code:

87529 x 2

Synonyms:

Herpes Simplex DNA; HSV DNA

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HSV PCR

Molecular Diagnostics : DNA

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