Occult Blood, Qual
| PATIENT INFO |
| Patient Name: |
| Medical Record #: |
| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
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| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
| Ph: ( ) - Fax: ( ) - |
| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. Occult Blood, Qual | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
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Test ID :
LAB3033
Specimen Type:
Stool
Tube Type:
Fecal Sample Collection Buffer Tube
Cause for Rejection:
Not collected in fecal collection buffer tube
Storage:
Ambient
Availability:
Daily, 24 hours; STAT
Methodology:
Immunochemical
Special Instructions:
Obtain a stool specimen. This may be obtained from a patient’s diaper or a collection hat. Unscrew the fecal collection tube cap and insert attached applicator stick into the fecal sample at 6 different sites. Use only enough sample to cover the tip of the applicator stick. Replace the applicator stick into the fecal collection tube and tighten cap thoroughly. Shake tube to mix the sample with the extraction buffer.
The following conditions may interfere with test results: menstrual bleeding, bleeding hemorrhoids, constipation bleeding, and urinary bleeding.
Lab/Phone:
330-543-8418
TAT:
Routine 4 hours; STAT 1 hour
Additional Info:
Reference range: Negative
CPT Code:
82274
Synonyms:
Hemosure Fecal Occult Blood
