Quantitative Culture

PATIENT INFO

Patient Name:

Medical Record #:

BD: / / Sex: F M

PHYSICIAN INFO

Physician Name :

Address:

Ph: ( ) - Fax: ( ) -

Additional Report to:

Ph: ( ) - Fax: ( ) -

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

QUANT

Test Workstation :

MIC2

Specimen Type:

1g of tissue in sterile container.

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:

Mon-Sun (0700-1600)

Methodology:

Culture

Lab/Phone:

330-543-8406

TAT:

72 hours

Additional Info:

This clinical test should be used for burn tissue and not for routine culture. For routine culture, please order Aerobe culture (LAB897).

CPT Code:

87071

Synonyms:

Quant Burn Culture; Quantitative Skin Culture