Meningitis/Encephalitis Film Array

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. Meningitis/Encephalitis Film Array
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

MEFLM/VIR1

Specimen Type:

CSF

Tube Type:

Sterile Container

Collection Volume:

500 uL

Storage:

Refrigerated

Availability:

Daily

Methodology:

Qualitative multiplexed nucleic acid-based in vitro diagnostic test utilizing polymerase chain reaction (PCR)

Lab/Phone:

330-543-8576

TAT:

Two hours from the time the specimen arrives in the Akron laboratory. Performed 24 hours, 7 days a week.

CPT Code:

87483

Panel Includes:

The FilmArray Meningitis/Encephalitis Panel detects DNA or RNA for the following organisms: E. coli, Haemophilus influenzae, Listeria monocytogenes, Neisseria meningitidis, Streptococcus agalactiae, Strep pneumoniae, Cytomegalovirus, Enterovirus, Herpes simplex virus 1, Herpes simplex virus 2, Human herpesvirus 6, Human Parechovirus, Varicella-zoster virus (VZV) and Cryptococcus neoformans/gatti.