Acid Fast 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. Acid Fast Culture | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
TBC/S
Test Workstation :
SUMMA
Specimen Type:
Sputum, BAL, Gastric aspirate, Urine, Tissue, CSF, Blood or Bone Marrow, Stool, Throat swab (ESwab) if unable to obtain sputum
Tube Type:
Specimen container, Isolator tube (blood or bone marrow)
Collection Volume:
Sputum:5-10 mL
Blood or Bone Marrow: 1.5 mL in Isolator tube
Gastric asp.: 5.0 mL or greater
Urine: First void 25-50 mL
BAL: 1.0 mL or greater
Cause for Rejection:
Specimen sent in nonsterile container. Sputum specimen consisting of all saliva. Specimens with insufficient volume will be rejected.
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Fluorescent Antibody Stain for AFB, Culture for AFB
Special Instructions:
For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly)
Lab/Phone:
330-543-8412
TAT:
AFB stain: 24 hours; AFB culture: 8 weeks
Additional Info:
Physician will be notified of positive stains and/or cultures
CPT Code:
87116
Synonyms:
Mycobacterial Culture; AFB Culture; TB Culture
