Environment Culture
| PATIENT INFO |
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| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
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| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
| Ph: ( ) - Fax: ( ) - |
| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. Environment Culture | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
ENVIR
Test Workstation :
MMIC2
Specimen Type:
Equipment Swab, Formula, Water, Autoclave strips
Tube Type:
Specimen container
Collection Volume:
5.0mL fluid (minimum 1.0mL or swab)
Cause for Rejection:
Specimen collected in nonsterile container
Storage:
Refrigerated
Availability:
Daily
Methodology:
Culture
Special Instructions:
Use Eswab to culture equipment. For fluid samples such as formula or dialysis water, please send at least 5.0mL for testing. Deliver to laboratory as soon as possible.
Lab/Phone:
330-746-9623
TAT:
48 hours
CPT Code:
87084
Synonyms:
Autoclave Culture; Respiratory Care Culture
