Blood Smear Review
| 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. Blood Smear Review | |
| 2. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
BSMRV
Test Workstation :
MAHM1
Specimen Type:
Blood
Tube Type:
Purple top ( EDTA ) tube: Whole Blood
Collection Volume:
0.3 mL and 2 fresh peripheral smears
Cause for Rejection:
Specimens which are hemolyzed, clotted, diluted with IV fluid, or collected in heparin.
Storage:
Refrigerated
Availability:
Daily, 24 hours
Methodology:
Microscopic evaluation of Wright's stained blood film
Special Instructions:
A differential from whole blood cannot be done on a specimen held more than 4 hours at room temperature or more than 8 hours refrigerated. On microsamples, the specimen cannot be used when it is more than 4 hours old if previous slides were not made.
Lab/Phone:
330-746-9623
TAT:
4 hours
Additional Info:
Reference range is available on patient report
CPT Code:
85007
