Body Fluid Cell Count and Differential
| 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. Body Fluid Cell Count and Differential | |
| 2. | |
| 3. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
FLC&D
Test Workstation :
MSCOP
Specimen Type:
Cerebrospinal fluid; Body fluid
Tube Type:
Fluid Container
Collection Volume:
2.0 ml CSF
Minimum Volume:
1.0 ml CSF
Preferred Volume:
2.0 ml CSF
Cause for Rejection:
Specimen more than 1 hour old, specimen grossly clotted
Storage:
Ambient
Availability:
Daily, 24 hours; STAT
Methodology:
Hemocytometer count and microscopic evaluation of Wright's stained cytocentrifuge preparation
Special Instructions:
Specify body fluid type
Lab/Phone:
330-746-9623
TAT:
1 hour
Additional Info:
Reference ranges available on patient report
CPT Code:
89051
Synonyms:
CSF Cell Count; Misc.
