Trichomonas Antigen
| 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. Trichomonas Antigen | |
| 2. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
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Test ID :
TRICS
Test Workstation :
MMIC1
Specimen Type:
Vaginal washing, or vaginal swab
Tube Type:
Collect vaginal specimens with 1 BBL Culture Swab. Swabs from vagina are placed back in the culturette. Do not use Eswabs, swabs with cotton tips or swabs with wooden shafts. Urine specimens are NOT acceptable for the Trichomonas Antigen Test.
Collection Volume:
1.0 mL
Minimum Volume:
1.0 ml
Preferred Volume:
1.0 ml
Cause for Rejection:
Insufficient Specimen; Eswab, Swabs with cotton tips, or wooden shafts are not acceptable. Urine specimens are NOT an acceptable specimen for the Trichomonas Antigen test.
Storage:
Ambient <24hrs or Refrigerated (up to 36hrs)
Availability:
Daily
Methodology:
Immunochromatographic Assay
Special Instructions:
Swabs from vagina are placed back in culturette or placed in sterile vial containing 1.0 mL sterile (nonbacteriostatic)saline.
Lab/Phone:
330-746-9623
TAT:
1 hour
Additional Info:
Validated for vaginal specimens.
CPT Code:
87808
