Parasite ID, Macroscopic

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. Parasite ID, Macroscopic
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

PARID MIC2

Specimen Type:

Tick, Worm for ID

Tube Type:

Specimen container

Cause for Rejection:

No specimen seen

Storage:

Refrigerated

Availability:

Daily

Methodology:

Parasite examination, Macroscopic

Special Instructions:

Tick or worm ID may require consultation with Medical Director.

Lab/Phone:

330-543-8412

TAT:

48-72 hours

CPT Code:

87169

Synonyms:

Tick ID, Worm ID

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