Rotavirus Ag
| 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. Rotavirus Ag | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
ROTA
Test Workstation :
MMIC1
Specimen Type:
Stool
Tube Type:
Stool container
Collection Volume:
5.0 mL (minimum 1.0 ml)
Minimum Volume:
1.0 ml stool
Preferred Volume:
5.0 ml stool
Cause for Rejection:
Stool specimen sent on a swab. Stool sent in viral transport media. Specimen sent in diaper. Rectal swab is not acceptable.
Storage:
Refrigerated
Availability:
Daily, 24 hours; STAT
Methodology:
Antigen detection by Immunochromatographic
Lab/Phone:
330-746-9623
TAT:
48 hours
CPT Code:
87425
Synonyms:
Stool for Rotavirus; Rotavirus Screen
