Fecal Leukocyte Stain

PATIENT INFO

Patient Name:

Medical Record #:

BD: / / Sex: F M

PHYSICIAN INFO

Physician Name :

Address:

Ph: ( ) - Fax: ( ) -

Additional Report to:

Ph: ( ) - Fax: ( ) -

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

LEUKO

Test Workstation :

MIC1

Specimen Type:

250mg (pea sized amount) of solid stool or 0.5 mL liquid stool in sterile container.

Minimum Volume:

Formed stool minimum volume is 125mg (pea sized amount). Liquid stool minimum volume is 0.2 mL.

Cause for Rejection:

Reject if Stool is >2 hours.

Storage:

Ambient

Availability:

Mon-Sun (0700-1600)

Methodology:

Microscopic examination

Lab/Phone:

330-543-8406

TAT:

24 hours

Additional Info:

Fecal leukocytes begin to degrade after 2 hours. If older than 2 hours, the test will be canceled and reflexed to Fecal Lactoferrin (LAB4158).

CPT Code:

87205

Synonyms:

Wright's Stain, Stool Smear for Leukocytes