Influenza Virus PCR

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. Influenza Virus PCR
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Test ID/Workstation :

INFPC VIR3

Specimen Type:

NPH flocked swab

Tube Type:

NPH flocked swab in M4 Viral transport medium

Collection Volume:

1 flocked swab

Storage:

Refrigerated

Availability:

Daily

Methodology:

Polymerase Chain Reaction (PCR)

Special Instructions:

Same day if received in Virology by 2:00 p.m. Saturday and Sunday: Same day if received in Virology by 11:00 a.m.

Lab/Phone:

330-543-8576

TAT:

2-24 hours

Additional Info:

Reference range: NEGATIVE. No Influenza RNA detected

CPT Code:

87502

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Influenza Virus PCR

Infectious Disease Laboratories : Virology

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