Chlamydia/Gonorrhoeae Amplified RNA
| 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. Chlamydia/Gonorrhoeae Amplified RNA | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
CGRNA
Test Workstation :
MAYO
Specimen Type:
Oropharyngeal or Rectal Swab
Tube Type:
Aptima Multitest Swab (Obtain from Laboratory)
Cause for Rejection:
Unlabeled specimen, QNS, contaminated
Storage:
Refrigerated
Availability:
Sent to reference laboratory
Methodology:
Transcription Mediated Amplification
Special Instructions:
1. Specimens must be collected using the Aptima Multitest Swab Collection Kit. Obtain from Laboratory.
2. Swab site using Aptima Multitest Swab. For rectal specimens, insert swab into rectum about 3 to 5 cm past anal margin and gently rotate swab for 10 seconds.
3. Place collection swab in transport tube provided in collection kit. Snap off swab at score line so swab fits into closed tube.
4. Cap tube securely, and label tube.
5. Refrigerate swab for transport.
Lab/Phone:
330-543-8418
TAT:
1-4 days
CPT Code:
87591 and 87491
Panel Includes:
Chlamydia Amplified RNA and Gonorrhoeae Amplified RNA
