KOH Preparation

Infectious Disease Laboratories - : Microbiology

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. KOH Preparation
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

KOH

Test Workstation :

MIC2

Specimen Type:

Skin, hair, or nails collected in sterile container.
Esophageal brush collected in sterile container with saline or sterile water.

Cause for Rejection:

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

Storage:

Ambient

Availability:

Mon-Sun (0700-1600)

Methodology:

Microscopic exam

Lab/Phone:

330-543-8406

TAT:

24 hours

Additional Info:

Vaginal specimens are not accepted. Please order Gram Stain - Vaginal (LAB4167).

CPT Code:

87220

Synonyms:

Fungal Smear; Microscopic Exam for Fungus

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KOH Preparation

Infectious Disease Laboratories - : Microbiology

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