Fetal Fibronectin (SUMMA)
| 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. Fetal Fibronectin (SUMMA) | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
FFN
Test Workstation :
SUMMA
Specimen Type:
Vaginal or Cervicovaginal
Tube Type:
Hologic FFN Collection Kit
Collection Volume:
0.2 mL
Minimum Volume:
0.1 mL
Cause for Rejection:
Specimen >3 days old, or not collected in Hologic FFN collection kit
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Solid Phase Immunochromatographic Assay
Special Instructions:
Care must be taken not to contaminate the swab or cervicovaginal secretions with lubricants, soaps, disinfectants, or creams. Lubricants or creams may physically interfere with absorption of the specimen onto a swab. Soaps or disinfectants may interfere with the antibodyantigen reaction.
Bloody or viscous specimens can cause interference with the testing method and result in an invalid result.
Lab/Phone:
330-543-8418
TAT:
1 Day
Additional Info:
Reference range: Negative or Positive
CPT Code:
82731
