Wound Culture
| 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. Wound Culture | |
| 2. | |
| 3. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
WOUND
Test Workstation :
MIC2
Specimen Type:
Eswab collected from wound lesion or abscess.
Cause for Rejection:
Quantity not sufficient, 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. Upon arrival in laboratory, store refrigerated.
Availability:
Mon-Sun (0700-1600)
Methodology:
Culture
Special Instructions:
Requisition must state specific site where specimen was taken along with any important information regarding patient diagnosis e.g. animal bite).
Lab/Phone:
330-543-8406
TAT:
4 days
Additional Info:
All wound cultures include a gram stain.
CPT Code:
87070
Synonyms:
Abscess Culture; Lesion Culture
