Quantitative Culture
| 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. Quantitative Culture | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
LAB271
Specimen Type:
2 grams of tissue in sterile container.
Tube Type:
Sterile container
Minimum Volume:
0.5 grams
Preferred Volume:
2.0 grams
Cause for Rejection:
Quantity not sufficient, improper specimen type, improper storage/transport, mislabeled, or unlabeled.
Storage:
Transport at room temperature. Upon arrival in laboratory, store refrigerated.
Availability:
Monday thru Sunday (08:00 - 15:00)
Methodology:
Culture
Lab/Phone:
330-543-8406
TAT:
72 hours
Additional Info:
This clinical test should be used for burn tissue only and not for routine culture. For routine culture, please order Aerobic culture (LAB897).
Other cultures, such as Anaerobic Culture, Fungal Culture, and Acid Fast Culture cannot be performed from the same tissue sample submitted for Quantitative Culture. If these cultures are indicated, either a separate tissue sample must be submitted, or the Quantitative Culture should be cancelled and replaced with the Aerobic Culture.
Other cultures, such as Anaerobic Culture, Fungal Culture, and Acid Fast Culture cannot be performed from the same tissue sample submitted for Quantitative Culture. If these cultures are indicated, either a separate tissue sample must be submitted, or the Quantitative Culture should be cancelled and replaced with the Aerobic Culture.
CPT Code:
87071
Synonyms:
Quant Burn Culture; Quantitative Skin Culture; Tissue Quantitative Culture
