Complete Blood Count with Differential (CBC WITH DIFF)
| 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. Complete Blood Count with Differential (CBC WITH DIFF) | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
CBC
Test Workstation :
MAHM1
Specimen Type:
Blood
Tube Type:
Purple top (EDTA) tube: Whole Blood
Collection Volume:
300 ul microtainer, 2.0 ml macrotainer
Minimum Volume:
300 ul microtainer; 1.0 ml mactrotainer
Preferred Volume:
300 ul microtainer, 2.0 macrotainer
Cause for Rejection:
Specimens hemolyzed, clotted diluted with IV fluid, drawn with heparin or contaminated with heparin; tubes improperly filled; specimens at RT for more than 8 hours or 4C for more than 24 hours
Storage:
Refrigerated
Availability:
Daily, 24 hours; STAT
Methodology:
Impedance measurement with Optical Flow light scatter and fluorescent measurements and microscopic evaluation of a Wright's stained blood film
Special Instructions:
Indicate clearly if the specimen has been drawn from an arterial line or from a line that has been rinsed with heparin.
Lab/Phone:
330-746-9623
TAT:
8 hours
Additional Info:
Reference ranges available on patient report
CPT Code:
85025
Profile Includes:
Synonyms:
Complete Blood Count; Hemogram & Smear Review; CBC with Diff
