Urine Culture

Infectious Disease Laboratories - : 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. Urine Culture
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

URINE

Test Workstation :

MIC2

Specimen Type:

1.0 mL cytoscopic urine, suprapubic urine, catheter collected urine, or clean catch mid-stream urine in sterile container.

Minimum Volume:

Urine minimum volume is 0.1 mL.

Cause for Rejection:

Quantity not sufficient, improper specimen type, improper storage/transport, mislabeled, or unlabeled. Urine specimens > 24 hours. Urine specimens obtained with the same collection method within 48 hours of receipt of first specimen will be rejected as a duplicate specimen.

Storage:

Transport refrigerated required from off campus location. Upon arrival in laboratory, store refrigerated for up to 24 hours.

Availability:

Mon-Sun

Methodology:

Culture

Lab/Phone:

330-543-8406

TAT:

72 hours

CPT Code:

87086

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Urine Culture

Infectious Disease Laboratories - : Microbiology

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