Cytospin Preparation
| 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. Cytospin Preparation | |
| 2. | |
| 3. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
PREP
Test Workstation :
SPHEM
Specimen Type:
Body fluid
Tube Type:
Fluid container
Collection Volume:
1.0 mL
Cause for Rejection:
Specimens more than 1 hour old, specimens grossly clotted
Storage:
Ambient
Availability:
Daily, 24 hours
Methodology:
Cytocentrifuge preparation
Special Instructions:
Specify body fluid type. Two or four cytospin preps will be prepared and sent to pathology for evaluation.
Lab/Phone:
330-543-8416
TAT:
1 hour
Additional Info:
Reference range: Done
CPT Code:
85999
