Genital Culture

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 :

GENIT

Test Workstation :

MIC2

Specimen Type:

Eswab collected from genital or urethral source.

Cause for Rejection:

Improper specimen type, improper storage/transport, improper swab, dry swab, swab not present, multiple swabs per vial, mislabeled, or unlabeled.

Storage:

Transport at room temperature and process within 24 hours.

Availability:

Mon-Sun

Methodology:

Culture

Special Instructions:

Do not send vaginal washes.

Lab/Phone:

330-543-8406

TAT:

72 hours

CPT Code:

87070

Synonyms:

Vaginal Culture; Cervical Culture; Urethral Culture