Vibrio 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. Vibrio Culture
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

VIBRO

Test Workstation :

MIC2

Specimen Type:

250mg (pea sized amount) of solid stool or 0.5 mL liquid stool in sterile container or in Cary-Blair medium.

Cause for Rejection:

Reject if Stool is >2 hours at room temperature, or >24 hours at 28C or Frozen. Sticks left in container will dry out stool.

Storage:

Refrigerated at 2-8C for <24 hours.

Availability:

Mon-Sun (0700-1600)

Methodology:

Culture

Lab/Phone:

330-543-8406

TAT:

72 hours

Additional Info:

This culture is for Vibrio only.

CPT Code:

87046

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