Rotavirus Ag

Laboratory - : 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. Rotavirus Ag
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

ROTA

Test Workstation :

MMIC1

Specimen Type:

Stool

Tube Type:

Stool container

Collection Volume:

5.0 mL (minimum 1.0 ml)

Minimum Volume:

1.0 ml stool

Preferred Volume:

5.0 ml stool

Cause for Rejection:

Stool specimen sent on a swab. Stool sent in viral transport media. Specimen sent in diaper. Rectal swab is not acceptable.

Storage:

Refrigerated

Availability:

Daily, 24 hours; STAT

Methodology:

Antigen detection by Immunochromatographic

Lab/Phone:

330-746-9623

TAT:

48 hours

CPT Code:

87425

Synonyms:

Stool for Rotavirus; Rotavirus Screen

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