Sputum 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. Sputum Culture | |
| 2. | |
| 3. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
SPUT
Test Workstation :
MIC2
Specimen Type:
1.0 mL sputum collected in sterile container.
Minimum Volume:
Sputum minimum volume is 0.5 mL.
Cause for Rejection:
Quantity not sufficient, improper specimen type, improper storage/transport, mislabeled, or unlabeled.
Storage:
Transport refrigerated required from off campus location. Upon arrival in laboratory, store refrigerated.
Availability:
Mon-Sun (0700-1600)
Methodology:
Culture
Special Instructions:
Cystic fibrosis patients must be designated as such on the requisition or audit trail accompanying the specimen. This clinical test includes a gram stain for nonCystic fibrosis patients.
Lab/Phone:
330-543-8406
TAT:
72 hours
CPT Code:
87070
