Urine 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. Urine Culture | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
URINE
Test Workstation :
MMIC2
Specimen Type:
Urine
Tube Type:
Urine Container
Collection Volume:
2.0 mL (minimum 0.5 mL)
Minimum Volume:
0.5 ml
Preferred Volume:
2.0 ml
Cause for Rejection:
Specimen received in unsterile container. Specimen older than 2 hours without refrigeration; Specimens > 24 hours
Storage:
Ambient <2 hours,Refrigerated up to 24 hours.
Availability:
Daily, 24 hours
Methodology:
Culture
Special Instructions:
Specify if urine was obtained by catheter or CCMS
Lab/Phone:
330-746-9623
TAT:
48 hours
Additional Info:
2 cultures containing 100,000 CFU/mL of the same organism is 95% confirmatory.
CPT Code:
87086
Synonyms:
Cath urine; Midstream urine; Clean catch urine culture
