SPECIMEN

COLLECTION
MANUAL
AND TEST

CATALOG

Shands at UF Rocky Point

1600 SW Archer Road 4800 SW 35th Drive
PO Box 100344 Gainesville, FL 32608
Gainesville, FL 32610-0344 352.265.0172
352.265.0037 352.265.0585 fax
352.338.9889 fax
Shands Medical Plaza
Shands Cancer Hospital at UF 2000 SW Archer Rd.
(Blood Bank) Gainesville, FL 32609
1515 SW Archer Road 352.265.0111, x87175
Gainesville, FL 32610
x30900 For Draw Station Locations, see inside.

Visit our web site: shands.org

Shands Medical Laboratories
Laboratory Licensure and Certification
n Shands Medical Laboratories are accredited by the HealthCare Financing Agency of the U.S.
Department of Health and Human Services under the Statutes of the Clinical Laboratory Improvements
Act. Our CLIA Numbers are 10D0997531, 10D0665884, and 10D0726675.

n We are licensed by the State of Florida Agency for Health Care Administration with license numbers
800000315, 80017098, and 800004146.

n We are accredited by the College of American Pathologists’ Commission on Laboratory Accreditation.

Our CAP laboratory numbers are 7178590, 1482301, and 1482314.

n We are licensed in:

Histocompatibility, Virology, General Immunology, Routine Chemistry, Urinalysis, Endocrinology,
Toxicology, Hematology, Histopathology, Immunohematology, Cytology, Parasitology, Bacteriology,
Mycology, Mycobacteriology and Molecular Pathology.

TELEPHONE NUMBERS

Shands Medical Laboratories

Customer Service, Gainesville, Florida................................................... (352) 265-0522

Chairman, Department of Pathology, Immunology

and Laboratory Medicine
Michael Clare-Salzler, MD ...................................................................... (352) 392-6840
 TABLE OF CONTENTS

Laboratory Contact Information................................................................................................. page 1

Collection of Specimens............................................................................................................. page 3

Cytology....................................................................................................................................... page 9

Hematopathology........................................................................................................................ page 12

Microbiology and Virology.......................................................................................................... page 15

Transfusion Services................................................................................................................... page 23

Transplant Lab............................................................................................................................. page 23

Comprehensive Test List............................................................................................................. page 24

Rocky Point Map, Draw Stations (Maps),

Cytology Request Form, Lab Test Order Form,
and Surgical Pathology Request Form................................................................................. Back of
..................................................................................................................................................... booklet
DEPARTMENT OF PATHOLOGY
Medical Directors

Name Medical Director Telephone Pager Fax

Clinical Pathology
Dr. Kenneth Rand x4-4875 888-543-1806 x5-0447
and Micro
Dr. Neil Harris Core Lab x4-4717 888-553-6799 x5-0437

Dr. Tisha Irwin Blood Bank x4-5188 413-7502 x5-0437

Dr. Martha Burt Autopsy 273-5891 491-3360 x6-1923

Dr. Ying Li Hemepath x7-2052 413-7468 265-1063

Dr. John Reith Surgical Pathology x4-4961 413-7504 x5-0437

Anatomic Pathology
Dr. Anthony Yachnis x4-4951 413-7518 x5-0437
and Neuropath
Dr. Larry J. Fowler Cytology x4-4959 413-1620 x5-0437

Dr. Juan Scornik Transplant x7-2030 413-7508 x5-9901

Dr. Vladimir Vincek Histology x7-2026 413-9548 x5-9901

Laboratory Administration............................................................(352) 265-0037

Kathy Gordon, MBA
Administrative Director

Rocky Point Core Laboratory.......................................................(352) 265-0172

Pam Core
Manager, Rocky Point Core Laboratory

Core Laboratories.........................................................................(352) 265-0412

Nisha Patel
Sr. Manager, Core Laboratories

Clinical Microbiology....................................................................(352) 265-0165

Clinical Virology............................................................................(352) 265-0333
Patricia Giglio
Manager, Clinical Microbiology

Blood Bank...................................................................................(352) 265-0377

Belinda Manukian
Interim Manager, Blood Bank

Anatomic Pathology, Transplant, and Hematopathology.............(352) 265-0172

Mary Reeves
Sr. Manager, AP, Transplant, and Hematopathology

Point of Care................................................................................(352) 265-0037

Abby Estilong and Arvid Olson
POC Coordinators

Compliance, Safety, and Quality Assurance................................(352) 265-0172

Agnieszka Avizinis

Laboratory Customer Service......................................................(352) 265-0522 1

Hospital Laboratories:

Shands Lake Shore....................................................... (386) 755-8240

Shands Live Oak............................................................ (386) 362-0800
Shands Starke............................................................... (904) 368-2360

Hospital Laboratory Locations:..........................Hours of Operation

Shands Lake Shore...............................................24 hours – 7 days

368 NE Franklin Street................................................... (386) 754-8240
Lake City, FL 32055
Nupur Shukla

Shands Live Oak........................................................ 24 hours – 7 days

1100 SW 11th Street...................................................... (386) 362-0800
Live Oak, FL 32060
Gayle Norris

Shands Starke............................................................ 24 hours – 7 days

922 East Call Street....................................................... (904) 368-2300
Starke, FL 32091
Keith Swart

Emergency Laboratory Specimen Collection:

Shands at UF Laboratory is open 24 hours a day, seven days per week for emergency laboratory testing.
Refer all patients to the Shands at UF Laboratory.

2
 COLLECTION OF SPECIMENS

VENIPUNCTURE PROCEDURE

Method: Percutaneous Venipuncture

Steps:
1. Identify self to patient.
2. Properly identify the patient using two unique identifiers. Acceptable identifiers are patient first and last name
and one of the following: date of birth, medical record number, social security number, or driver’s license
number.
3. Verify diet restrictions.
4. Position patient lying on back with face up or sitting with the appropriate site exposed.
5. Wash hands thoroughly and apply clean gloves.
6. Select venipuncture site.
a. DO NOT USE an extremity with an A-V shunt or status/post mastectomy.
b. DO NOT USE a site with extensive scarring.
c. DO NOT USE a site with a hematoma.
d. DO NOT USE a site with an IV.
7. Prep overlying skin with alcohol using a circular motion. Chloraprep may be used if patient is allergic to
alcohol.
8. Before using, tap all tubes that contain additives to ensure that the entire additive is dislodged from the
stopper and the wall of the tube.
9. Make sure patient’s arm or other venipuncture site is in a downward position to prevent reflux.
10. Apply tourniquet to extremity 2 inches proximal to desired site.
11. Identify target vein with palpation and visualization.
12. Use thumb to apply tension downward distal to insertion site.
13. Verbally state to patient that the venipuncture is starting and insert the needle at a 15-30˚ angle and
¼ to ½ inches below the intended entry into the vein.

Venipuncture procedure when evacuated tubes are used:

1. Insert blood collection tube into holder and onto needle up to the recessed guideline on the Vacutainer®
adapter.
2. Position the needle with the bevel up and the shaft parallel to the path of the vein.
3. Insert needle through skin at 15-30˚ angle and ¼ to ½ inches below intended entry into vein.
4. Grasp the flange of the needle adapter and push the collecting tube forward until the needle punctures the
stopper. Observe for flow of blood into stopper. Maintain tube below the needle.
5. Remove tourniquet as soon as possible once blood flow is established.
6. Keep constant, slight forward pressure on the end of the tube to prevent release of shut-off valve and stop of
blood flow.
7. Fill the tube until the vacuum is exhausted and blood flow ceases.
8. When blood flow ceases, remove the tube from the holder. The shut-off valve recovers the point, stopping
blood flow until the next tube is inserted.
9. Tubes containing additives should be mixed immediately upon draw by inverting 5-10 times. To avoid
hemolysis, do not mix vigorously.
10. To obtain additional specimens, insert the next tube into the holder and repeat steps 7-9.

3
Venipuncture procedure when using needle and syringe:
1. Position the needle with the bevel up and the shaft parallel to the path of the vein.
2. Insert sterile needle or butterfly through the skin at a 15-30˚ angle ¼ to ½ inches below the intended entry
into the vein.
3. Pull back on plunger or syringe slowly until sufficient volume of sample is achieved.
4. Release tourniquet.
5. Withdraw needle and syringe.
6. Apply pressure to site with gauze pad.
7. Pierce stopper of collection tube with needle; the evacuated tube will fill to the correct amount of blood.
8. Immediately activate the safety feature according to manufacturer instructions and discard without assembly
into a sharps container.
9. Check patient’s arm to ensure bleeding has stopped.
10. Apply gauze pad secured lightly with tape to the puncture site.
11. Instruct patient to leave bandage in place for at least 15 minutes.
12. Label all blood tubes at patient’s time of draw.
13. Place labeled specimens in biohazard bag.
14. Discard gloves and wash hands.
15. Place specimen at courier pickup station for processing.

Venipuncture procedure when multiple specimens are collected:

1. Obtain blood specimen using the following “order of draw.”
a. Blood culture tubes or vials
b. Non-additive (e.g., PLAIN RED)
c. Coagulation tube (e.g., BLUE)
d. Serum tube with or without clot activator, with or without gel (e.g., RED, GOLD, or SPECKLE)
e. Heparin tube with or without gel plasma separator (e.g., GREEN)
f. EDTA (e.g., LAVENDER, PINK or PEARL)
g. Glycolytic inhibitor (e.g., GRAY)
NOTE:
• Plastic serum tubes containing a clot activator may cause interference in coagulation testing. Glass non-
additive serum tubes may be drawn before the coagulation tube.
• When using a winged blood collection set (butterflies) for venipuncture and a coagulation tube is the first
tube to be drawn, a discard tube should be drawn first. The discard tube must be used to fill the blood
collection tubing dead space and to assure maintenance of the proper anticoagulant/blood ratio and
need not be completely filled. The discard tube should be a non-additive tube.
2. Release the tourniquet as soon as possible after the blood begins to flow.
3. Fill lab tubes with appropriate volume.
4. Apply pressure to site with gauze pad.
5. Apply bandage or gauze pad secured lightly with tape to puncture site.
6. Immediately activate the safety feature according to manufacturer instructions and discard without assembly
into a sharps container.
7. Label tubes at patient’s draw station.
8. Place labeled lab specimen in biohazard bag.
9. Discard gloves and wash hands.
10. Send specimens to courier pick up station for processing.

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 SPECIMEN LABELING REQUIREMENTS
Positive patient identification must be made. The specimen is to be labeled at the time of collection with the
following:
1. Patient’s first and last name
2. A second form of identification
Acceptable second identifiers include: date of birth, medical record number, social security number, or
driver’s license number.
NOTE: Samples collected for transfusion compatibility testing require a 3rd identifier in the form of a
Blood Bank ID# derived from the application of the Blood Bank ID band.
3. Date and time of collection
4. Initials of phlebotomist
NOTE: SPECIMENS NOT MEETING THESE REQUIREMENTS WILL BE REJECTED.

The following general procedures should be observed when collecting the following samples:

The volume requirements of blue top tubes for coagulation tests such as PT or
Blue Top tubes PTT are very specific. The tube should be filled precisely to the required volume
with a free flowing sample.

Betadine or other non-alcoholic solution should be used for disinfecting the arm
Ethanol (Alcohol) testing
prior to sampling. Do NOT use alcohol preps.

Blood Cultures The following procedure should be used to obtain a sample for blood cultures.

Blood culture collection procedure:

1. For each request for blood cultures on adults when a time or location is not specified by the doctor, two sets
of two bottles will be drawn. Each set of aerobic and anaerobic blood culture bottles will be obtained from
two different sites. Samples will NOT be taken from an arterial line, heparin lock or a subclavian IV unless
specifically ordered by the attending physician.
2. After selecting a good phlebotomy site, the tourniquet will be released and the site disinfected.
3. The site will be cleansed first with chloraprep® using a concentric spiral motion moving from the site
outward.
4. Prep the site using an iodine prep using the same motion working from the site outward. Allow the iodine to
dry before drawing specimen.
NOTE: If the patient is allergic to iodine, another topical disinfectant may be used. Any deviation from routine
collection should be noted on the request form or sample bottles.
5. Perform the venipuncture and draw the sample according to procedure. Sample should flow freely.
6. Carefully change syringe needle and blood transfer device and place 8-10mL of blood into each vial using
aseptic technique. Be sure not to contaminate bottle tops before entering bottle with needle. Label and
send to lab as soon as possible. Treat patient according to current post-phlebotomy procedures. (See
venipuncture methods lists on previous pages.)

5
WHOLE BLOOD, SERUM or PLASMA COLLECTION
The most common sample of laboratory testing is whole blood serum or plasma. The preferred collection method for
adults is venipuncture using vacuum collection tubes. The method of collection is similar for whole blood, serum or plasma
except for the anticoagulant used. The color of the stopper of the collection tube specifies the anticoagulant content.

Blood should be obtained from a freely flowing venipuncture performed according to current nursing or
laboratory venipuncture procedure. (See previous pages for venipuncture procedure.) Tubes should be collected
in the following stopper color order – red, blue, other. All tubes, except red top tubes, should be inverted gently
several times in order to mix the anticoagulant. Adequate volume should be collected for the number and types
of tests requested. Minimum blood volumes are noted in the collection manual for each test. If insufficient
volume is collected, call the laboratory before sending.

SPECIMEN COLLECTION TUBE GUIDE

Min. Vol. mix # of
Lab Tube Type Additive Tests
times
Chemistry
LIGHT GREEN Lithium heparin 3 mls 8 Majority of chemistry testing

GOLD Preferred Clot activator

(with gel separator) 6 mls 5 Lithium, electrophoresis, folate, and cadaveric viral testing
clots in 30 min
OR

RED 5 mls
clots in 1hr
(w/o gel)

LAVENDER K2EDTA 5 mls 8 FK506 , cyclosporin, and ammonia testing

potassium
GRAY oxalate/ 3 mls 8 Glucose determination
sodium fluoride

Hematology
LAVENDER K2EDTA 5 mls 8 Hematology determinations

LIGHT GREEN Lithium heparin 3 mls 8 Joint crystal determination

LIGHT BLUE 4.5mls

or
3.2 % sodium 3/4 Coagulation determination
citrate
CLEAR 1.8mls
(smaller size)

Transplant Citrate Dextrose

HLA phenotyping, DNA testing, and *HLA crossmatch (donor’s cells) testing
YELLOW solution A 8.5mls 8
* both donor’s cells and recipient’s serum required
(ACD-A)

HLA antibody, and *HLA crossmatch (recipient’s serum) testing.

GOLD Clot activator 6mls 5 *both donor’s cells and recipient’s serum required
(with gel separator) clots in 30 minutes

Hemato-
pathology LAVENDER K2EDTA 5mls 8 Immunophenotyping by flowcytometry

GREEN Sodium Heparin 5mls 8 Send outs - cytogenetics

Blood bank Blood bank testing.

PINK K2EDTA 6mls 8 Samples must be accompanied with
a Transfusion Services Time Out Verification Form.

Virology
WHITE K2EDTA 5mls 8 CMV and BKV DNA PCR testing
(with gel separator)

GOLD Clot activator 6mls 5 Infectious disease testing

(with gel separator) clots in 30 minutes

LAVENDER K2EDTA 3mls 8 EBV PCR testing

For send out specimen requirements call (352) 265-0111 ext. 72200 or 72201

6
CAPILLARY PUNCTURE
Capillary puncture may be used for obtaining specimens in infants or in adults where venipunture is difficult.
Specimens from infants under the age of 6 months are usually collected by heelstick. Above 6 months,
fingerstick collection is usually used. Microtainers are available for collection and are color-coded similar to
vacuum tubes – red for serum specimens and lavender for EDTA whole blood or plasma. A translucent brown
microtainer is available for bilirubin analysis.

The capillary puncture should be made with a sterile lancet according to current nursing or laboratory capillary
collection procedure. The first drop of blood containing tissue and tissue fluid should be wiped away, and the
blood collected from the clean flow of blood from the wound. Care should be taken not to squeeze the finger or
leg excessively in order to avoid sample hemolysis. After collection, the collection tube should be capped and
inverted several times to mix the anticoagulant. Do NOT shake. Label each tube before sending. (See labeling
requirements.)

RANDOM URINES
Unless otherwise specified, random urine collection should be the first morning urine collected using clean
catch mid stream technique. If a catheter is used for collection, the collection should be made from the free
flow in the tube, not the bag. The specimen cup should be capped and properly labeled before transporting to
the lab. The outside of the container should be clean and dry. Samples for urine culture should be collected in
a sterile container. If another test is requested on the culture sample, an aliquot should be poured off into a new
container, labeled and sent with a separate request slip.

Random urines should be sent to the laboratory as soon as possible after collection or else refrigerated unless
otherwise indicated.

TIMED URINES
Timed urines are usually collected during a 2 or 24 hour time period. The normal amount of urine collected over a
24-hour period ranges from 800 to 2000mL. The laboratory supplies the containers to be used for the collections
with the appropriate preservative added. The requesting location should send a message or a request slip to
the laboratory with the name of the patient, the patient location and the test requested to the laboratory so that
a 24-hour urine container can be prepared. Containers containing caustic or dangerous preservatives will be
labeled with warning stickers and patients should be cautioned not to urinate directly into the container.

The time that the initial sample was discarded (beginning time) and the time of the last sample collected (ending
time) should be noted on the label and the requisition. All volumes of urine between these two times should be
added to the sample. If an aliquot has been lost or need to be used for another purpose and the total volume of all
lost aliquots represent less than 10% of the collection, the amount of the lost volume should be noted on the label
and the collection may be continued. If the volume of the submitted sample is less than 200mL the laboratory will
suggest a recollection unless the patient’s physician feels that the submitted volume is appropriate.

URINE PRESERVATION METHODS

Preservatives are used to keep the substance to be measured in the urine sample stable during the collection
period. The preservative is required to be added to the sample collection container before the collection of the
specimen begins.

WARNING: Some preservatives are caustic and the sample containers will be labeled as such. Collect each
sample in another container and pour into collection container.

URINE PRESERVATIVES
Keep urine refrigerated or on wet ice during collection. Send to lab as soon as possible after
ON ICE
completion of collection.
Collect urine in a container in which 4 grams of dry boric acid has been added either as a
BORIC ACID
powder or in a table form before collection.
Collect urine in a container in which 30mL of 6 N hydrochloric acid has been added to
HCL
container before collection.

7
STOOL SAMPLES
Fecal specimens for analysis should be collected in a plastic or water-impermeable stool container. If the sample
cannot be sent to the laboratory right away, preservative containers supplied by the laboratory may be used for
O&P and culture samples. Contamination of stool samples by urine, laxatives and barium should be avoided.
Diaper samples are not suitable for cultures.

Call lab for instructions in collecting stool samples for ova and parasites.

SPUTUM SAMPLES
Sputum collection should be made by deep cough. If a culture is requested on a sample that does not demonstrate
alveolar dust cells or contains large amounts of epithelial cells, the laboratory will request a recollection.

TRANSPORT OF SPECIMENS BY SHANDS COURIER SERVICES

All diagnostic specimens shall be transported to and from the Rocky Point facility in a manner as to prevent
contamination of workers, patients or the environment. Samples should be transported in approved, inherently
safe, leakproof containers. Specimens with needles are NOT accepted. Refer to Hospital Laboratory
Infection Control Policy (Sections III E and VII) located at http://intranet.shands.org/ic/p/Departmental/
Departmental/17~Core%20Lab.pdf.

Samples transported by couriers should be triple-packaged. The original specimen container must be leak-
tight and inserted into a secondary bag with sufficient absorbing material to absorb accidental spill of the entire
specimen volume. The outer packaging (cooler) must be designated and labeled for biohazards only and secured
against the movement during transport. The operator of motor vehicles that transport specimens must be trained
as to the hazards they transport. Refer to courier protocol Transporting Specimens (CS.c006.1205) located on
Shands Intranet Lab Web site and CFR 173.6 (a)(4) - Materials of Trade Exceptions for Couriers.

8
 CYTOLOGY

ALL SPECIMENS MUST BE SUBMITTED IN CLOSED CONTAINERS, PROPERLY LABELED, AND

TRANSPORTED IN BIOHAZARD BAGS!

SPECIMEN COLLECTION OTHER THAN FNAs

BREAST SECRETION: Secretion from the nipple can be obtained in up to 70% of women who have borne
children. There are two procedures that are acceptable for handling of the breast cytology specimen. They are as
follows:

1. Six slide technique: Secretion from the nipple is expressed on six slides, labeled with the patient’s
last name. As the drop of secretion appears, the first slide is gently brought to the drop and the
secretion is smeared on the slide using a slide push technique as employed in Hematology. In this
technique, a second slide is simply brought up to the drop, the drop is permitted to spread across
the joining edges of the slide and, at that point, the forwarding slide is pushed across the surface
smearing the sample. The sample is immediately placed into 95% alcohol or sprayed using an
appropriate fixative, being certain the spraying nozzle is at least 12 inches away from the sample.

2. Breast secretion employing the cytocentrifuge technique: Collection of the sample employing these
technologies requires that the sample preferably be collected fresh in a clean covered container
and submitted directly to the section of Cytopathology. In these cases at least 2 mL of sample is
generally required to perform cytologic evaluation. If the sample cannot be submitted directly to
Cytopathology, the sample must be refrigerated until it can be delivered to Cytopathology. The
sample should be submitted to the section of Cytopathology with the appropriate requisition form.

3. Fine needle aspiration may also be used for breast masses.

CORNEAL (EYE) samples are collected by the ophthalmology clinicians and submitted as air-dried smears often
requesting GMS (silver) stains. The slide, which must have the patient’s name written on the frosted end, is given
an accession number and submitted to Histology for a Gomori methanamine silver stain (when requested) and
evaluated for the presence of fungi.

If the request states “Rule out acanthamoeba” the protocol established for this laboratory by the medical director
is that the submitted slide should be stained with Gomori methanamine silver stain – fungal stain with a light green
counterstain to detect both acanthamoeba and fungal organisms. (Ref: Medical Microbiology p 1178)

Fluid samples from the eye should be transported immediately to the Cytopathology lab for process or, if delayed,
refrigerated.

EFFUSIONS-ASCITES, PLEURAL OR PERICARDIAL: If a specimen can be transported promptly to the lab,

we prefer the fresh fluid. If it cannot be brought immediately, add 3 units of heparin per mL of fluid as precaution
against clotting, and place in refrigerator until it can be delivered. We prefer at least 30 mL of sample or more if
possible.

FEMALE GENITAL TRACT - CERVICAL VAGINAL CYTOLOGY: The patient’s last name MUST be printed in
pencil on the frosted end of the slide BEFORE the smear is taken and spread. An endocervical brush aspirate is
recommended unless the patient is pregnant. The endocervical sample should be obtained and placed on the slide
before the cervical scrape is made with the spatula, or placed on a separate slide. Obtain the cervical scraping
from the complete transformation zone by rotating the spatula 360 degrees around the cervix at least twice.
Spread the material obtained in a rotating clockwise fashion, with the spatula, on the clear end of the slide and
place immediately in 95% ethanol or spray IMMEDIATELY with an appropriate fixative, keeping the spray nozzle 12
inches from the slide surface. DO NOT ALLOW SMEAR TO AIR DRY!! Please supply pertinent clinical information,
especially patient’s age and menstrual history. A vaginal pool sample is rarely of value in screening for cervical
carcinoma.

9
THINPREP PAPS:
Obtain an adequate sample. (See ThinPrep Pap kit for detailed collection information.) Rinse spatula/broom in
preservative solution and discard collection device. Tighten the cap on vial and label with the patient’s name
before placing in transport bag. HPV, GC and CT testing is now available.

GASTROINTESTINAL TRACT: Brushing or aspirated material may be smeared directly on slides, which should
have the patient’s last name printed in pencil on one end. The smears should be fixed IMMEDIATELY in 95%
ethanol and the slides brought to Cytopathology. The brush used in the procedure may be submitted in a small
(10 ml) amount of saline for processing with prepared slides.

RESPIRATORY TRACT: Sputum - Instruct the patient to cough deeply (from the diaphragm) to expectorate a deep
cough specimen and not saliva. We prefer a fresh unfixed sample or the specimen may be refrigerated until it can
be delivered to the Cytopathology lab. For best results, a series of early morning specimens should be submitted
each morning for 3 consecutive days.

BRONCHIAL: Send fresh bronchial secretions or washings to lab immediately or refrigerate until specimen can be
delivered to Cytopathology for processing.
NOTE: Bronchoalveolar lavage is preferred for detection of Pneumocystis carinii.
If slides are made, print the patient’s name with pencil on one end of all-frosted slides, smear brushing or aspirated
material and fix the slide immediately in 95% ethanol. DO NOT ALLOW SMEAR TO AIR DRY!! The brush may
also be placed in saline and submitted. Do not forget to send three post-bronchoscopy sputum specimens to the
lab, obtained over the next 3 days. These are rich in exfoliated cells from the bronchial epithelium and are of great
diagnostic value.

SPINAL FLUID: Bring the fresh specimen PROMPTLY to the Lab for processing. A sample size of at least 1-3 mL
is needed. If a lymphoproliferative disorder is suspected, submit the CSF to Hematopathology for analysis.

URINARY TRACT: For Cancer Detection - Send fresh urine or bladder washing immediately to the Cytopathology
Lab, please indicate whether specimen is voided or catheterized urine or bladder washing. If specimen cannot be
brought immediately to the lab, it MUST be refrigerated.

For Cytomegalic Inclusion Disease (CMV) Detection – Fresh urine should be sent IMMEDIATELY to the
Cytopathology Lab after collection. A 5 mL minimum volume is required. (Culture for CMV is preferred for detection).

For Polyoma (BK virus) cytologic changes – Follow procedure for urines above.

WOUND OR LESION SCRAPES: Print patient’s last name with pencil on one end of all-frosted slide, scrape the
wound with moistened tongue blade and place the material directly on slides. Place the slides IMMEDIATELY in
95% ethanol, or spray with an appropriate fixative, keeping the spray nozzle 12 inches away from the slide surface.
If the wound is hard and crusted it should be soaked with warm saline prior to obtaining the scrape.

NOTE: “Tzanck” smears for viral changes are unreliable and non-specific. Virology testing is
recommended.

10
COLLECTION OF FINE NEEDLE ASPIRATION

PURPOSE

The purpose of Fine Needle Aspiration is to obtain diagnostic cells from a designated site without using open
biopsy techniques.

PRINCIPLE

Tissue is obtained from a specific anatomic site with or without the aid of radiological assistance. The tissue is
evaluated at the site to ensure that diagnostic tissue has been obtained.

SPECIMEN

Fine needle aspiration of masses for cytological examination.

ALL SPECIMENS MUST BE SUBMITTED IN CLOSED CONTAINERS, PROPERLY LABELED, AND

TRANSPORTED IN BIOHAZARD BAGS!

SMEARS:
When submitting non-Gyn smears it is important to indicate which are spray-fixed and which are air-dried, as
these are handled differently.

SPUTUM:
In cases where a sample is to be shared between Cytology and Microbiology, a cytology request form should
accompany the specimen to the lab.

11
HEMATOPATHOLOGY
Our scope of service includes:
• Diagnostic service is dedicated exclusively to the analysis and interpretation of hematologic neoplasia
and related disorders. All traditional and relevant modern diagnostic technologies are available, including
histology, cytology, immunohistochemistry, flow cytometry, cytogenetics and molecular genetics. The
state-of-the-art telepathology equipment is used to transmit images and data between Shands at Rocky
Point and Shands at the University of Florida.

• Service is covered by full-time MD hematopathologists. Director of the Hematopathology Service has

over 30 years experience in Hematopathology, flow cytometry and other laboratory diagnostic methods.
Associated pathologists have at least 2 years of full-time comprehensive Hematopathology training.

• Physicians are available 24 hours/7 days a week for consultation. Special arrangements must be made
for off hours and Sunday specimens.

• Rapid turnaround time. Diagnosis of diseases that require prompt management are routinely reported
via telephone by one of the consulting physicians. Reports are faxed and original reports are sent by
regular mail.

Consultations Offered
1. Comprehensive leukemia evaluation
2. Comprehensive lymphoma/lymphoproliferative evaluation
3. Comprehensive plasma cell disorder evaluation
4. Disease Monitoring
5. Consultation on microscopic materials
6. Performance of specialized hematologic laboratory tests on blood, bone marrow or other fluids
7. CD34(+) stem/progenitor cell quantitation

12
 Shands Hematopathology Consultation Services
Specimen Submission Guidelines
If possible, please notify the laboratory staff by phone or a fax request when sending a specimen. Special
arrangements must be made for off hours and Sunday specimens.

Laboratory number: (352) 265-0071

Fax number: (352) 265-1063
Sample Type Sample Requirement Instructions
• 1-2 tubes in EDTA (lavender top) + Cold pack or wet ice
Peripheral Blood (other than
freshly-prepared smear No dry ice
cytogenetics)
• Provide WBC and differential count

Bone Marrow (other than • 3-5 mL in EDTA (lavender top) + freshly- Cold pack or wet ice
cytogenetics) prepared smear No dry ice

• Provide WBC and differential count

Peripheral blood or bone • 10 mL blood or 2-3 mL bone marrow in Cold pack or wet ice
marrow for cytogenetics heparin (green top) No dry ice

Bone Marrow Biopsy • Fresh, unfixed biopsy core in RPMI, Cold pack or wet ice
similar culture medium or saline No dry ice

Needle Aspirates • Collect in RPMI, similar culture medium Cold pack or wet ice
or saline No dry ice

• Submit freshly prepared smear or

cytology

Fluids • Spin large volume and send cell pellet Cold pack or wet ice
in RPMI or similar culture medium No dry ice

• No anticoagulant unless grossly

contaminated with blood

Tissue-Fresh (unfixed) • Fresh fragment kept moist in saline at Cold pack or wet ice
all times (cover with saline or wrap in No dry ice
medium-soaked gauze)
(For a control, please send a representative
portion of the biopsy, fixed in formalin, if
available)

Histology slides
• Place in unbreakable container Room temperature

• Submit corresponding paraffin blocks

13
HISTOPATHOLOGY

Our Scope of Service Includes:

• The Histopathology Laboratory processes surgical specimens from inpatient and outpatient populations.
Preparations are made for light microscopy, fluorescent antibody tests and immunoperoxidase
techniques using paraffin and frozen section techniques, respectively. This laboratory also prepares
microscopic sections from all autopsies performed at Shands Teaching Hospital.

• The Histopathology Laboratory performs a wide variety of tests on tissue sections for demonstration of
many organisms, substances and structures. These tests include the demonstration of bacteria, fungi,
protozoans and inclusion bodies; pigments and minerals; carbohydrates and mucoproteins; fats and
lipids; nerve cells and fibers; hematologic and nuclear elements; cytoplasmic granules and connective
tissue elements. The laboratory also performs test for enzymes including the phosphatases and
esterases.

TISSUE

Tissue samples for histologic analysis should be submitted in fixative (10% zinc formalin). The sample should
be submitted in a leak-proof container that is properly labeled and accompanied by a Tissue Request form (see
labeling and request form requirements below). Multiple specimens on the same patient should be listed on the
same request form, making sure that each specimen is listed on the form the same way they are listed on the
container label. Once the histology laboratory has received a specimen, it may not leave the laboratory without
the expressed consent of the pathologists.

Tissue samples for bacterial culturing must NOT be sent in formalin. These samples should be sent in a dry
sterile container, sterile saline solution or wrapped in sterile gauze.

Shands Histopathology
Specimen Submission Guidelines

• Specimen should be properly labeled, including the patient’s name, medical record number, date of birth and
source of the specimen. Each specimen must be submitted with the Surgical Pathology Requisition Form .
REQUEST FORM REQUIREMENTS:
• First and last name of patient • Submitting physician’s name
• Date of birth • Date and time collected
• Sex • Pertinent clinical history
• Address • Source of specimen
• Social security number • Insurance information
• Bone Marrow Core Biopsies: place specimen in 10% Zinc Formalin available from the Histology Lab and
deliver to the Hematopathology Lab at Shands at Rocky Point. Each specimen must be submitted with Bone
Marrow Worksheet.
• Specimens for Immunofluorescence: deliver fresh tissue on saline soaked gauze to the Gross Room at
Shands at UF.
• Muscle Biopsies (performed at Shands at UF): deliver fresh tissue on saline soaked gauze to the Gross Room
at Shands at UF.
• Muscle Biopsies (performed at an outside hospital): contact the Histology Laboratory at Shands at Rocky
Point before obtaining specimen, 1-352-265-0680 ext. 7-2117.
• Routine Light Microscopy: place tissue in 10% Zinc Formalin (volume of Zinc Formalin 20 times tissue
volume) and deliver to Gross Room at Shands at UF.
• Surgical Pathology Consults: submit slides, a copy of the corresponding Pathology report from the referring
location and a completed Surgical Pathology Requisition Form to Surgical Pathology at Shands at UF.
14
MICROBIOLOGY

The Microbiology Department provides full-service Microbiology, Virology, Serology, Parasitology, Mycology,
and Mycobacteriology testing for Shands at UF, Shands AGH, Shands Starke, Shands Live Oak and multiple
outpatient facilities. The Microbiology Department is located at Shands at UF and is directed by a board-certified
Infectious Disease physician, managed by a masters level Supervisor and Technical Specialist, and staffed by
medical technologists and medical laboratory technicians who are licensed by the State of Florida Board of
Professional Regulations. Technical personnel staff the Microbiology Laboratory 24 hours a day, 7 days a week
and samples can be received at any time.
Shands HealthCare has maintained rapid growth and expansion of microbiology services. The laboratory
has dedicated and qualified personnel committed to providing excellent quality of service using advanced
technology and professional attention to each patient specimen.
Specimens of urine, feces, sputum, surgical biopsies, tissue, wounds, blood, CSF and body fluids are submitted
for culture and processed in microbiology. The specimens are inoculated onto a variety of differential and
selective media and incubated for growth and identification of potential pathogenic organisms. Antimicrobial
susceptibility testing is performed and the results are used by the physician to evaluate which antibiotic would
be most appropriate for patient care.

The Microbiology Laboratory is constantly striving to improve and expand the quality and scope of service
offered.

COLLECTION
• Each specimen should be considered potentially infectious and handled using Standard Precautions.

• Each specimen should be collected properly in tightly capped containers to avoid leakage and possible
rejection of the specimen.

• The most appropriate specimens for isolation of anaerobes are tissue or fluids submitted in anaerobic
transport tubes.

• Blood cultures for bacteria consist of one silver labeled Aerobic bottle and one purple labeled Lytic
bottle, with optimal blood volumes of 8-10 mLs each. Pediatric draws (1-3mLs) can be inoculated into a
pink-labeled Peds Plus (aerobic) bottle.

15
 Instructions for Microbiology Specimen Collection and Transport
Specimen Collection Equipment Transport Instructions (Comments)
Anaerobe Optimum recovery of anaerobes Do not refrigerate. Use 1. Avoid all 02 exposure.
occurs with tissue or curetting, anaerobe transport 2. Use Ana transport tubes or expel air
which can be placed into the tube or syringe without from syringe.
anaerobic collection container. needle. 3. DO NOT submit needle-syringe;
Aspirates collected in syringe syringe with cap only.
(submitted without needles) are 4. Label properly.
the next best specimen. Swabs 5. Send two tubes if STAT gram stain is
are the least likely to yield requested.
clinically relevant results. 6. Deliver promptly to lab.
Blood/ Bactec Blood culture collection Aer F & Ana Lytic F 1. Decontaminate puncture site -
Bone kit. Needle & syringe. bottles require 8-10 mL Hibistat.
Marrow blood/bottle. May use 2. Do not palpate disinfected site.
minimum of 3 mL. [all 3. Decontaminate bottle stopper with
resinated] Peds Plus /F Hibistat.
bottles used for short 4. Label properly.
draws (1-3mLs) Do NOT 5. Deliver promptly to lab.
REFRIGERATE.
CSF Surgical prep & collection by Transport in CSF 1. Surgical prep of puncture site
physician. collection tube. DO NOT refrigerate.
2. Obtain 4-5 mL (optimal for adults) 0.5-
1.0 mL for children
3. Handle as EMERGENCY specimen;
hand carry to laboratory.
4. One tube only, send to bacteriology
first. Second and/or third, routinely to
bacteriology
5. Label properly.
6. Deliver promptly to lab.
Ear Aspirate from Transport medium 1. Clean external ear surface.
tympanocentesis. Swab of 2. CAREFULLY culture representative
drainage. area.
3. Label properly.
4. Deliver promptly to lab.
Eye Swab (small) for each eye Transport medium 1. Do not touch external skin.
Corneal scrapping (by 2. Obtain maximum material.
physician). 3. Label properly.
Feces Clean or sterile collection cup. Refrigerate if not 1. Best specimen is diarrhea stool.
Swab (only if necessary) May processed within 1 hour 2. Swab is satisfactory in acute
use clean vial of 2-vial kit for cases but not necessary for routine
Parasitology. 1 specimen/day specimens.
No culture accepted after 3rd 3. Insert swab beyond anal sphincter.
hospital day. Swab must show feces.
4. Label properly.
5. Deliver promptly to lab.
Feces for Clean vial; no preservative 1. Label properly.
Lactoferrin (5grams) 2. Deliver promptly to lab.
Genital Swab. 1. Collect culture with a swab inserted
through a speculum.
2. Avoid touching swab to uninfected
surfaces.
3. Clean external urethra before taking
urethra specimen.
4. For GC, inoculate TM at bedside, if
possible.
5. Label properly.
6. Deliver promptly to lab.

16
 Instructions for Microbiology Specimen Collection and Transport (cont.)
Specimen Collection Equipment Transport Instructions (Comments)
Nasopharynx Calcium alginate swab Do not refrigerate 1. Nasal speculum helpful.
Transport medium. 2. Pass through the nose into nasopharynx.
3. Allow to remain for a few seconds.
4. Carefully withdraw.
5. Label properly.
6. Deliver promptly to lab
Nose Swab Transport medium. 1. Swab anterior nares only.
2. Culture quickly.
3. Label properly
4. Deliver promptly to lab
Sinus Swab (small) Transport medium 1. Insert and remove quickly.
2. Label properly
3. Deliver promptly to lab.
Sputum Sterile cup (Minimum 5mL) Refrigerate if needed. 1. Carefully instruct pt. to cough deeply
Transport in collection (not to spit)
cup. 2. First morning specimen is best. (no 24hr
collection)
3. Transport immediately: seal container
tightly.
4. Consider sputum contaminated with TB.
5. Label properly
6. Deliver promptly to lab.
Throat Swab Transport medium if 1. Use tongue blade.
more than 2hr delay 2. Sample only back of throat between &
around tonsil area thoroughly.
3. Avoid cheeks, teeth etc.
4. Label properly
Urine Sterile screw cap cup or Transport in collection 1. Give patient clear & detailed instructions.
transport tube/media/vial container. Refrigerate 2. Clean with soap, not disinfectant.
(Minimum 10 mL) quickly. 3. Refrigerate no longer than 24 hrs. prior
to culture.
4. Seal container tightly.
5. Label properly
6. Deliver promptly to lab.
Superficial Sterile container, swab/ Transport to lab quickly. 1. Disinfect surface with Hibistat.
Wound syringe 2. Aspirate deepest portion of lesion.
3. Swab affected area. Crush ampule of
culturette.
4. Send to lab immediately.
Burn Sterile container; swab Transport to lab quickly. 1. Disinfect surface with Hibistat.
Wound 2. Swab area - crush ampule of culturette.
Send to lab.
3. Use dermal punch. Obtain 3-4mm punch
bx. No Formalin. Deliver promptly to lab.

Serology specimens

TEST ACCEPTABLE SPECIMEN UNACCEPTABLE SPECIMEN

Cryptococcal Antigen Serum or CSF (1mL)

Legionella Antigen Urine (10mL) 24 hr urine

Test
Mono Serum (1mL) hemolyzed,
markedly lipemic, contaminated serum

17
VIROLOGY
GC and Chlamydia by DNA Testing Collection Procedure
The BDProbeTec™ ET System is designed to detect the presence of Chlamydia trachomatis and Neisseria
gonorrhoeae in endocervical swabs, male urethral swabs and male and female urine specimens using the
appropriate collection method.
Endocervical
Collection Endocervical Specimen Collection:

• Use the BD ProbeTec Cleaning - Collection and Transport System

• Remove excess mucus from the cervical os with the large-tipped cleaning swab provided in the BD
ProbeTec Cleaning-Collection and Transport System and discard.
• Insert the BD ProbeTec collection swab into the cervical canal and rotate for 15 - 30 sec.
• Withdraw the swab carefully. Avoid contact with the vaginal mucosa.
• Immediately place the cap/swab into the transport tube. Make sure the cap is tightly secured to the
tube.
• Label the tube with patient information and date/time collected.
Urethral
Collection Male Urethral Specimen Collection:
• Use the Mini-Tip BD ProbeTec Collection and Transport System
• Insert the Mini-Tip BD ProbeTec swab 2 - 4 cm into the urethra and rotate for 3 - 5 sec.
• Withdraw the swab and place the cap/swab into the transport tube. Make sure the cap is tightly
secured to the tube.
• Label the tube with patient information and date/time collected.
Urine
Collection Urine Specimen Collection:
• The patient should not have urinated for at least 1 h prior to specimen collection.
• Collect specimen in a sterile, plastic, preservative-free specimen collection cup.
• The patient should collect the first 15 - 20 mL of voided urine (the first part of the stream - not
midstream).
NOTE: During the clinical evaluation, testing urine volumes up to 60 mL was included in the
performance estimates.
• Label with patient identification and date/time collected.
Specimen • The BD ProbeTec collection swab and the Mini-Tip BD ProbeTec collection swab must
Transport be transported to the laboratory within 4-6 days of collection if stored and transported at
2-27ºC. If specimens are refrigerated at 2-8ºC after collection and during transport, then
they can be submitted up to 10 days after collection. Urine specimens can be stored and
transported to the test site at 2-30ºC within 24 hours. Otherwise all urine specimens should
be stored and transported at 2-8ºC.

Shipping • The BD ProbeTec collection swab, the Mini-Tip BD ProbeTec collection swab, and urine
Instruction specimens must be shipped in an insulated container on ice (cold packs) by either an overnight
or 2-day delivery vendor.
Specimen
Rejection Specimens will be rejected for any of the following reasons.
• Swabs or tissue not submitted in correct collection container.
• Specimens not labeled with the patient’s correct name and medical record number.
• Specimens from a patient on any type of isolation, which are not properly bagged and labeled with
the isolation precautions.
• Specimens that are leaking out of their containers.

18
BD ProbeTec Cleaning - Collection and Transport System

Mini-Tip BD ProbeTec Collection and Transport System

(continued on next page)

19
 Sterile Urine Container

Collection and Handling of Specimen for Virus Isolation

All specimens must be delivered to the specimen accession window, room 3164 or to the Diagnostic
Virology Lab, room 3163, within thirty minutes. All specimens for culture are to be put on ice or refrigerated
immediately. Specimens must be labeled with the patient’s name and medical record number and must be
accompanied by order labels and/or a completed Order Request form. Physicians or nurse should collect
all specimens using aseptic technique and the following specifications:

• Sterile containers, clean-catch mid-stream, or catheterized specimens only.

Urine
• Order test: vcur

• Obtain specimen with flocked swab contained in the Viral Transport pack. After
specimen collection, insert the swab into the liquid Viral Transport medium and then
break off the end carefully. Cap the vial securely to avoid leakage. When swabbing
a lesion, it is best to scrape the base of a fresh lesion after lancing, using sterile
NP and techniques.
Lesion
• Order test VCRESP for NP, NP WASH, NP Aspirates, BAL, and Throat specimens;
VCLES for lesions; VCEYE for eye swab; or VCGEN for genital specimens.

• If any specimen is to be tested for Herpes only, order VCHSV.

• Submit in a sterile container (no additive) or obtain specimen with flocked swab
contained in the Viral Transport pack. Partially insert swab into transport medium
and break off the end, trying not to contaminate the part of the swab going into the
media. Replace the cap tightly to avoid leakage.
Stool
• If unable to obtain stool, using Viral Transport media and a swab as above, collect
rectal swab with visible amount of stool.

• Order vcst

• (CSF, Pleural, etc...) 1 .0 to 5 .0 mL in a sterile tube

Sterile
Fluids • Order test vccsf for CSF and vcasp for other source of body fluids

20
 • Place in Viral Transport Media
Tissues
• Order vcbx

• Collect bone marrow in green top (heparin) tube and mix well. Hold at room temperature
Bone Marrow and deliver to Virology lab immediately upon collection. Only available from 8:00 am to
(Buffy coat- 2:00 pm, Monday through Friday.
WBC culture)
• Order vcbm

Viral Transport Media (Star Swab)

Viral
Transport Viral Transport packs are available from Owens and Minor or CDC (Hospital Store #1300910)
Media and should be available at all inpatient nursing units.

Specimens will be rejected for any of the following reasons.

• Cultures left unrefrigerated for more than 2 - 3 hours.
Specimen
• Swabs or tissue not submitted in viral transport media.
Rejection
• Specimens not labeled with the patient’s correct name and medical record number.

• Specimens that are leaking out of their containers.

21
 Collection of Fluorescent Antibody Stains

• HSV Fluorescent Antibody Stain

Fluorescent
• RSV Fluorescent Antibody Stain
Antibody Stains
Performed in • Adenovirus Fluorescent Antibody Stain
the Virology
• VZ Fluorescent Antibody Stain

Smears should be made by the physician at the patients bedside, allowed to air dry, and
held at room temperature until transported to the lab.
• Obtain two glass slides for each virus that is requested for testing.

• Label the slides with the patients name and medical record number
Procedure for • Make a dime size smear in the middle of the slides
Collection
• Allow to air dry (do not cover slip)

• Place in a container (that is appropriately labeled) to prevent slides from breaking

during transit

• Transport to lab with order labels and/or order forms

22
TRANSFUSION SERVICE (BLOOD BANK)

The Blood Bank Department’s dedicated and qualified personnel are committed to providing the highest level
of quality service and blood products. The blood bank department provides a wide span of immunohematology
services using the most advanced technology to assist the physician in obtaining quality test results as well
as quality blood products for the patient. Numerous blood products are available to the ordering physician in
order to manage the diversified group of patients that are encountered here at Shands Cancer Hospital at the
University of Florida. The blood bank hours of operation are 24 hours/7days a week.

Our Scope of Service includes:

• Blood Bank Laboratory Tests
• Blood Products
• Pathology Consultations

Other Related Services include:

• Autologous/Directed Donations

TRANSPLANT LABORATORY (HLA)

The Transplant Laboratory performs compatibility tests, transplant monitoring for stem cell, kidney, pancreas,
heart, lung, liver transplantation and other immunological testing. The tests offered are described below
according to the clinical application. The laboratory is staffed from 7:00 am -11:30 pm, Monday through Friday.
The technologist on call is available by pager (352-413-0194) after hours and on weekends/holidays.

Services Provided Include:

1. Organ Transplant Evaluation

o Heart

o Liver

o Kidney

o Lung

o Pancreas

2. Stem Cell Transplant Evaluation

3. Other Immunological Evaluation

o B27

o Narcolepsy

o HLA typing for platelet transfusions

23
 SHANDS MEDICAL LABORATORIES: Laboratory Collection Requirements Date: 01/01/2002 Revised: 1/11/07

24

KEY:
SPECIMEN REQUIREMENTS: TAT:
24HR UR - 24 HOUR URINE COLLECTION (NOTE PRESERVATIVE) PWR: Performed when received, < 72 Hours.
BLUE: BLUE TOP TUBE (CITRATED NA) Routine: <4 Hours
GRAY: GRAY TOP TUBE (K OXALATE AND NA FLUORIDE) STAT: < 60 Minutes
GREEN: GREEN TOP TUBE (SODIUM HEPARIN)
LAV: LAVENDER/PURPLE TOP TUBE (POTASSIUM EDTA)
RED: RED TOP TUBE (NO PRESERVATIVES OR ANTICOAGULANTS)
ROYAL BLUE: ROYAL BLUE TOP TUBE (ACID WASHING CONTAINING EDTA)
SST (Gold): SERUM SEPARATOR TUBE (SST/GEL) STAT:
URINE RANDOM: RANDOM URINE IN STERILE CONTAINER Y: Performed STAT
YELLOW ACID: YELLOW TOP TUBE (ACD SOLUTION) N: Not performed STAT
PINK: BLOOD BANK EDTA
PPT: PEARL TOP TUBE (EDTA/GEL)
Current test methods are available upon request including performance specifications.

SQ CODE TEST NAME CPT SPECIMEN REQUIREMENTS ML NOTES TAT STAT METHOD
17CORT 17-HYDROXYCORTICOSTEROIDS 83491 24HR UR BORIC ACID PRESERVATIVE 25 ML REQUEST CONTAINER <7 days N Porter-Silber
17KETU 17-KETOSTEROIDS 83586 24HR UR-BORIC ACID PRESERVATIVE 25ML REQUEST CONTAINER <7 days N Spectrophotemetry
5HIAAB 5-HIAA 83497 24HR UR - HCL PRESERVATIVE 25 ML REQUEST CONTAINER <7 days N HPLC
ABR ABO/RH TYPE 86900/86901 PINK 2.0 ML NOTE LABELING REQUIREMENTS - NO EXCEPTIONS <24 Hours Y Hemagglutination
DAT DIRECT COOMBS 86880 PINK 2.0 ML NOTE LABELING REQUIREMENTS - NO EXCEPTIONS <24 Hours Y Hemagglutination
ACETAM ACETAMINOPHEN (TYLENOL) 82003 RED -NO GEL TUBES 2.0 ML <4 Hours Y Spectrophotemetry
ARABAC ACETYLCHOLINE BIND AB 83519 RED 3.0 ML <7 days N RIA
APCPBT ACTIVATED PROT C RESISTANCE 85307 BLUE - TUBE MUST BE FULL 4.5 ML <10 days N Clotting
ADENFA ADENOVIRUS BY FA 87260 SLIDE 1 <3 days N FA
ACTHBA ACTH 82024 LAV 6.0 ML DRAW BETWEEN 7 AM AND 10 AM <7 days N Chemiluminescent
ALBBFB ALBUMIN, BODY FLUID 82042 SST/Gold 2.0 ML STATE SOURCE <72 Hours Y Spectrophotemetry
ALB ALBUMIN, SERUM 82040 SST/Gold 2.0 ML <4 Hours Y Spectrophotemetry
ALDOLB ALDOLASE 82085 RED 4.0 ML <7 days N Enzymatic
ALDOSS ALDOSTERONE 82088 RED 4.0 ML <7 days N RIA
ALDOUR ALDOSTERONE, URINE 82088 24HR U -BORIC ACID PRESERVATIVE 10.0 ML REQUEST CONTAINER <7 days N RIA
APISOB ALK PHOS FRACTIONATION 84080 SST/Gold 2.0 ML <7 days N Heat Inactivation/Enzymatic
AL1ANT ALPHA 1 ANTITRYPSIN 82103 SST/Gold 3.0 ML <7 days N Immunoturbidimetric
AFP4BT AFP, MATERNAL 82105 SST/Gold 3.0 ML <10 days N Chemiluminescent
AFPUF AFP, NON-MATERNAL 82105 SST/Gold 3.0 ML <7 days N Electrochemiluminescent Assay
XANAX ALPRAZOLAM (XANAX) 80154 RED - NO GEL TUBES 3.0 ML <10 days N GC
ALT ALT (SGPT) 84460 SST/Gold 2.0 ML <4 Hours Y Enzymatic
ALUMSR ALUMINUM 82108 ROYAL BLUE 7.0 ML <7 days N Inductively Coupled Plasma/MS
AMIK AMIKACIN, RANDOM 80150 RED - NO GEL TUBES 2.0 ML <4 Hours Y FPIA
AMIKP AMIKACIN,PEAK 80150 RED - NO GEL TUBES 2.0 ML <4 Hours Y FPIA
AMIKT AMIKACIN,TROUGH 80150 RED - NO GEL TUBES 2.0 ML <4 Hours Y FPIA
AAPLQT AMINO ACID QUANTITATIVE 82139 GREEN 4.0 ML CRITICAL FROZEN <10 days N Ion Exchange Chromatography
AAQLUR AMINO ACID SCR URINE 82139 URINE RANDOM 10.0 ML CRITICAL FROZEN <7 days N Ion Exchange Chromatography
 SQ CODE TEST NAME CPT SPECIMEN REQUIREMENTS ML NOTES TAT STAT METHOD
AAQLPL AMINO ACID SCREEN 82139 GREEN 4.0 ML CRITICAL FROZEN <10 days N Ion Exchange Chromatography
AMITB AMITRIPTYLINE (ELAVIL) 80152 RED 3.0 ML <7 days N HPLC
NH3UF AMMONIA 82140 LAVENDER ON ICE 4.0 ML MUST BE REC’D IN LAB WITHIN 30 MIN <4 Hours Y Colorimetry
AMYISO AMYLASE ISOENZYMES 82150 SST/Gold 3.0 ML <7 days N Enzymatic
AMYBFB AMYLASE, BODY FLUID 82150 SST/Gold 2.0 ML STATE SOURCE <72 Hours Y Enzymatic
AMYL AMYLASE, SERUM 82150 SST/Gold 2.0 ML <4 Hours Y Enzymatic
AMYURI AMYLASE, URINE 82150 URINE RANDOM 2.0 ML 1-3 days N Enzymatic
ANAB ANA PANEL 86038 SST/Gold 3.0 ML <72 Hours N ELISA
ACEB ANGIOTENSIN CONV ENZ (ACE) 82164 SST/Gold 3.0 ML <7 days N Spectrophotemetry
ACLB ANTI CARDIOLIPIN 86147 x2 BLUE - TUBE MUST BE FULL 4.5 ML <10 days N ELISA
AVHB ANTI DIURETIC HORMONE 84588 LAV 7.0 ML DRAW IN PRECHILLED TUBES AND TRANSPORT ON ICE <10 days N RIA
NDNAAB ANTI DNA (DOUBLE STRANDED) 86225 SST/Gold 2.0 ML 1-3 days N ELISA
SMRNP ANTI ENA (SM/RNP) 86235 SST/Gold 2.0 ML <7 days N ELISA
AGBM ANTI GLOMERULAR BASEMENT 83516 SST/Gold 5.0 ML <10 days N ELISA
THYGLB ANTI THYROGLOBULIN AB 86800 SST/Gold 3.0 ML <7 days N Chemiluminescent
THYMIC ANTI THYROID MICROSOMAL AB 86376 SST/Gold 3.0 ML <7 days N ELISA
CENTRB ANTICENTROMERE AB 86039 SST/Gold 3.0 ML <7 days N ELISA
GLPEAB ANTIGLIADIN AB 83516 x2 SST/Gold 3.0 ML <7 days N ELISA
NEUAB ANTINEUTROPHIL AB 86021 SST/Gold 3.0 ML <10 days N ELISA
ANCA ANCA 86255 SST/Gold 2.0 ML <72 Hours N ELISA
ANPHOB ANTIPHOSPHOLIPID AB 86147 x2 BLUE - TUBE MUST BE FULL 4.5 ML <10 days N ELISA
ASMA ANTI-SMOOTH MUSCLE AB 86255 SST/Gold 2.0 ML <7 days N ELISA
ASO ANTISTREPTOLYSIN 0, ASO 86060 SST/Gold 3.0 ML <72 Hours N ELISA
ATIII ANTITHROMBIN III 85300 BLUE - TUBE MUST BE FULL 4.5 ML PERFORMED ON FRIDAYS <7 days N Clotting
ASPEAB ASPERGILLUS ANTIBODY 86606 SST/Gold 5.0 ML <7 days N ELISA
AST AST (SGOT) 84450 SST/Gold 2.0 ML <4 Hours Y Enzymatic
B2MSB B2 MICROGLOBULIN 82232 SST/Gold 4.0 ML <7 days N Chemiluminescent
BASIC BASIC METABOLIC PANEL 80048 SST/Gold 7.0 ML <72 Hours Y Refer to Individual Components
BHCGUF B-HCG, QUANT. 84702 SST/Gold 3.0 ML <4 Hours Y Electrochemiluminescent Assay
TBIL BILIRUBIN SERUM 82247 SST/Gold 3.0 ML <4 Hours Y Spectrophotemetry
BILBFB BILIRUBIN, BODY FLUID 82247 SST/Gold 3.0 ML STATE SOURCE <72 Hours Y Spectrophotemetry
ETOH BLOOD ALCOHOL (ETOH) 82055 SST/Gold 3.0 ML FILL TUBE - DO NOT REMOVE CAP <4 Hours Y Enzymatic
PROBNP B-Natriuretic Peptide (BNP) 83880 SST/Gold 1.0ML <4 Hours Y Electrochemiluminescent Assay
BRUCAT BRUCELLA AB 86622 SST/Gold 3.0 ML <7 days N ELISA
CDIFF C DIFFICILE TOXIN 87324 STOOL - CLEAN CONTAINER 1.0 GM <72 Hours N EIA
CPEPTB C PEPTIDE 84681 SST/Gold 3.0 ML <7 days N Chemiluminescent
C1ESTE C1 ESTERASE INHIBITOR 86160 SST/Gold 3.0 ML <7 days N Nepholometry
CAB153 CA 15-3 86300 SST/Gold 3.0 ML <7 days N Electrochemiluminescent Assay
CA125T CA-125 86304 SST/Gold 3.0 ML <72 Hours N Electrochemiluminescent Assay
CA199 CANCER ANTIGEN 19-9 86301 SST/Gold 2.0 ML <72 Hours N Electrochemiluminescent Assay
CALCIB CALCITONIN 82308 SST/Gold 6.0 ML <7 days N Chemiluminescent
ICAS CALCIUM IONIZED, SERUM 82330 SST/Gold 3.0 ML FILL TUBE - DO NOT REMOVE CAP <4 Hours Y ISE/pH Electrode
CA CALCIUM, SERUM 82310 SST/Gold 2.0 ML <72 Hours Y Spectrophotemetry
CAUR CALCIUM, URINE 82340 URINE RANDOM 2.0 ML <72 Hours N Spectrophotemetry
CA24HR CALCIUM,URINE 24HR 82340 24HR UR - HCL PRESERVATIVE 5.0 ML REQUEST CONTAINER <72 Hours N Spectrophotemetry
TEGBT CARBAMAZEPINE 80156 RED - NO GEL TUBES 2.0 ML <4 Hours Y FPIA
CEA CEA 82378 SST/Gold 2.0 ML <72 Hours N Electrochemiluminescent Assay

25
 SQ CODE TEST NAME CPT SPECIMEN REQUIREMENTS ML NOTES TAT STAT METHOD

26
CARNFT CARNITINE (FREE & TOTAL) 82379 SST/Gold 5.0 ML <7 days N Tandem MS
CAROTB CAROTENE 82380 RED - PROTECT FROM LIGHT 5.0 ML <7 days N Spectrophotemetry
CATPL CATECHOLAMINES, TOTAL 82384 GREEN 5.0 ML <7 days N HPLC
CATUR CATECHOLAMINES, URINE 82384 24HR UR - HCL PRESERVATIVE 20.0 ML <7 days N HPLC
CBCUF CBC 85027 LAV 2.0 ML <4 Hours Y Automated Cell Count
CBCDUF CBC WITH DIFFERENTIAL 85025 LAV 2.0 ML <4 Hours Y Automated Cell Count with Flow Cell Differential
CD48 CD4/CD8 RATIO 86359/86360 LAV 5.0 ML DO NOT REFRIGERATE <72 Hours N Flow Cytometry
CSFCNT CELL COUNT & DIFF, SPINAL 89051 CSF 2.0 ML <4 Hours Y Cell Count/Differential
BDFCT CELL COUNT & DIFF. BODY FLUID 89051 STATE SOURCE 2.0 ML <4 Hours Y Cell Count/Differential
CERULO CERULOPLASMIN 82390 SST/Gold 2.0 ML <7 days N Immunoturbidimetric
CHLAM CHLAMYDIA CULTURE 87110 VIRAL TRANSPORT N/A <7 days N Culture
CL CHLORIDE 82435 SST/Gold 2.0 ML <4 Hours Y Ion-Selective Electrode
CLU24H CHLORIDE UR 24 HR 82436 24HR UR -PLAIN/REFRIGERATE 15.0 ML REQUEST CONTAINER <72 Hours N Ion-Selective Electrode
CLUR CHLORIDE, URINE 82436 URINE RANDOM 5.0 ML <72 Hours N Ion-Selective Electrode
CHOL CHOLESTEROL, SERUM 82465 SST/Gold 2.0 ML <72 Hours Y Enzymatic
COLPAN CHOLINESTERASE PANEL 82480 LAV 7.0 ML <7 days N Enzymatic
PSECHO CHOLINESTERASE, PSEUDO 82480 SST/Gold 3.0 ML <7 days N Enzymatic
COLRCB CHOLINESTERASE, RBC 82482 LAV 5.0 ML <7 days N Enzymatic
CHROMA CHROMOGRANIN A 86316 SST/Gold 3.0 ML <7 days N EIA
CHRMB CHROMOSOME, BLOOD 88262/ GREEN 5.0 ML DO NOT REFRIGERATE 14-21 days N FISH
88230/88291
CITUR CITRATE, 24 HR URINE 82507 24HR UR - PLAIN/REFRIGERATE 10.0 ML REQUEST CONTAINER <7 days N Enzymatic
CK CK (CREATINE KINASE) 82550 SST/Gold 2.0 ML <4 Hours Y Enzymatic
CKISO CK-MB ISOENZYME 82553 RED OR GREEN 3.0 ML <4 Hours Y Electrochemiluminescent Assay
CLONA CLONAZEPAM 80154 RED - NO GEL TUBES 4.0 ML <7 days N GC
CLOZA CLOZAPINE 80299 LAV 7.0 ML <7 days N HPLC
CMVBAT CMV DNA PCR 87496 PPT 7.0 ML <10 days N PCR
CMVG CMV IGG AB 86644 SST/Gold 2.0 ML <7 days N ELISA
CMVM CMV IGM AB 86645 SST/Gold 2.0 ML <7 days N ELISA
CO2 CO2 82374 SST/Gold 2.0 ML <4 Hours Y Enzymatic
COLDAG COLD AGGLUTININS 86157 SST/Gold 2.0 ML KEEP AT 37 DEGREES CENTIGRADE 1-2 days N Hemagglutination
C1QB COMPLEMENT, C1Q 86161 SST/Gold 3.0 ML <7 days N Hemolytic Assay
C3 COMPLEMENT, C’3 86160 SST/Gold 3.0 ML <72 Hours N Immunoturbidimetric
C4 COMPLEMENT, C’4 86160 SST/Gold 3.0 ML <72 Hours N Immunoturbidimetric
CH50 COMPLEMENT, TOTAL (CH 50) 86162 SST/Gold 3.0 ML <7 days N Hemolytic Assay
COMPA COMPREHENSIVE METABOLIC P 80053 SST/Gold 5.0 ML <4 Hours Y Refer to Individual Components
COPPER COPPER 82525 ROYAL BLUE 5.0 ML 5-10 days N ICP/MS
CRTFUR CORTISOL FREE, URINE 82533 24HR UR-BORIC ACID PRESERVATIVE 20.0 ML REQUEST CONTAINER <7 days N Tandem MS
CORT CORTISOL, SERUM 82533 SST/Gold 3.0 ML <72 Hours N Chemiluminescent
COXAB COXSACKIE A AB 86658 SST/Gold 5.0 ML <7 days N CF
COXBB COXSACKIE B AB 86658 x6 SST/Gold 5.0 ML <7 days N Serum Neutralization
HSCRP CRP, HIGHLY SENSITIVE 86141 SST/Gold 3.0 ML <7 days N Immunoturbidimetric
CREACL CREATININE CLEARANCE 82575 24HR UR - PLAIN/REFRIGERATE/RED 10.0 ML REQUEST CONTAINER- NOTE: BLOOD MUST BE
COLLECTED WITHIN 24 HOUR URINE COLLECTION <72 Hours Y Enzymatic
CREA CREATININE, SERUM 82540 SST/Gold 2.0 ML <4 Hours Y Enzymatic
CREAUR CREATININE, URINE 82540 URINE RANDOM 2.0 ML <4 Hours Y Enzymatic
CREBFB CREATININE,BODY FLUID 82570 RED 2.0 ML STATE SOURCE <4 Hours Y Enzymatic
 SQ CODE TEST NAME CPT SPECIMEN REQUIREMENTS ML NOTES TAT STAT METHOD
CRYO CRYOGLOBULIN, SERUM 82595 SST/Gold 5.0 ML Collect: Whole blood must be drawn in a pre-warmed (37°C)
syringe and kept at 37°C. Immediately after blood has been
obtained, transfer specimen to a pre-warmed (37°C) plain red and
keep specimen at 37°C until clotting is complete. Specimen may
be drawn directly into a pre-warmed collection tube and
maintained at 37°C until centrifugation. Let clot for one hour at
37°C. Separate serum from cells using a 37°C centrifuge, if possible. N Cold Precipitation
CRYAG CRYPTOCOCCAL ANTIGEN 87327 STERILE CONTAINER 2.0 ML STATE SOURCE-CSF OR SERUM <4 Hours Y Enzyme Immunoassay
ANER CULTURE - ANAEROBIC 87075 STERILE CONTAINER N/A STATE SOURCE - 2 TUBES IF GRAM STAIN STAT VARIABLE N Culture
EYEC CULT - EYE ONLY 87070 STERILE CONTAINER N/A STATE SOURCE VARIABLE N Culture
ACTINO CULT - ACTINOMYCES 87075 STERILE CONTAINER N/A STATE SOURCE VARIABLE N Culture
AFBC CULT - AFB 87116 STERILE CONTAINER N/A STATE SOURCE VARIABLE N Culture
AMOEBA CULT - AMOEBA 87081 STERILE CONTAINER N/A STATE SOURCE VARIABLE N Culture
BSS CULT - BETA STREP SCREEN 87081 STERILE CONTAINER N/A STATE SOURCE VARIABLE N Culture
BLF CULT - BLOOD, FUNGAL 87040 OBTAIN MEDIA FROM LAB N/A BLOOD OR BONE MARROW ONLY VARIABLE N Culture
FLDASP CULT - BODY FLUID 87070 STERILE CONTAINER N/A STATE SOURCE VARIABLE N Culture
BRONCH CULT - BRONCHIAL 87070 STERILE CONTAINER N/A STATE SOURCE VARIABLE N Culture
BRUCC CULT - BRUCELLA 87040 AEROBIC BLOOD CULTURE BTL N/A STATE SOURCE VARIABLE N Culture
CDIPTH CULT - C DIPTHERIA 87081 STERILE CONTAINER N/A NP SWAB VARIABLE N Culture
CATHTP CULT - CATH TIP 87071 STERILE CONTAINER N/A STATE SOURCE VARIABLE N Culture
CSFGS CULT - CSF 87070 CSF CONTAINER N/A STATE SOURCE VARIABLE N Culture
CFRESP CULT - CYSTIC FIBROSIS RESPIRATORY 87070 STERILE CONTAINER N/A STATE SOURCE VARIABLE N Culture
EC0157 CULT - E COLI 0157 87046 STOOL N/A VARIABLE N Culture
FUNG CULT - FUNGUS 87102 STERILE CONTAINER N/A STATE SOURCE VARIABLE N Culture
GC CULT - GC 87081 THAYER MARTIN N/A STATE SOURCE-SWAB OR INOCULATE AT BEDSIDE VARIABLE N Culture
GENC CULT - GENITAL 87070 STERILE CONTAINER N/A STATE SOURCE VARIABLE N Culture
MYCOPL CULT - MYCOPLASMA 87109 STERILE CONTAINER N/A STATE SOURCE-FOR PTS <6MOS OLD VARIABLE N Culture
PERTUS CULT - PERTUSSIS 87081 OBTAIN MEDIA FROM LAB N/A STATE SOURCE-SEND SWAB ALSO VARIABLE N Culture
RESP CULT - RESPIRATORY 87070 STERILE CONTAINER N/A STATE SOURCE VARIABLE N Culture
SPUTGS CULT - SPUTUM 87070 STERILE CONTAINER N/A STATE SOURCE VARIABLE N Culture
STOOL CULT - STOOL OR RECTAL SW 87045 STERILE CONTAINER N/A STATE SOURCE VARIABLE N Culture
URCUL CULT - URINE 87088 STERILE CONTAINER N/A STATE SOURCE VARIABLE N Culture
VIBRIO CULT - VIBRIO 87046 STERILE CONTAINER N/A STATE SOURCE VARIABLE N Culture
WNDC CULT - WOUND 87070 STERILE CONTAINER N/A STATE SOURCE VARIABLE N Culture
YERSC CULT - YERSINIA 87046 STOOL N/A STATE SOURCE VARIABLE N Culture
BLC CULT- BLOOD 87040 BLOOD CULTURE BOTTLE FROM LAB N/A STATE SOURCE VARIABLE N Culture
CYCLST CYCLOSPORA 87177 STOOL N/A 1-2 days N O&P
CYCLO CYCLOSPORINE 80158 LAV 5.0 ML <72 Hours N FPIA
CYSU24 CYSTINE 24 HR URINE 82131 24HR UR - PLAIN/REFRIGERATE 20.0 ML REQUEST CONTAINER <10 days N Ion Exchange Chromatography
ALAB D-AMINOLEVULINIC ACID 82135 24HR UR - PLAIN/REFRIGERATE 10.0 ML PROTECT FROM LIGHT <7 days N Ion Exchange Chromatography
DDIMER D-DIMER 85378 BLUE - TUBE MUST BE FULL 4.5 ML <4 Hours Y Clotting
DESIPB DESIPRAMINE (NORPRAMINE) 80160 RED 5.0 ML <7 days N FPIA
TRAZO DESYREL (TRAZODONE) 80299 RED 3.0 ML <7 days N HPLC
DHEASB DHEA SULFATE 82627 SST/Gold 3.0 ML <7 days N Electrochemiluminescent Assay
DHEAB DHEA UNCONJUGATED 82627 RED 3.0 ML <10 days N Electrochemiluminescent Assay
DIAZ DIAZEPAM (VALIUM) 80154 x2 RED - NO GEL TUBES 3.0 ML <7 days N GC
DIGIT DIGITOXIN (NOT DIGOXIN) 80299 RED - NO GEL TUBES 4.0 ML <7 days N FPIA
DIG DIGOXIN 80162 SST/Gold 4.0 ML <4 Hours Y EIA

27
 SQ CODE TEST NAME CPT SPECIMEN REQUIREMENTS ML NOTES TAT STAT METHOD

28
DITEST DIHYDROTESTOSTERONE 82651 RED 6.0 ML <7 days N RIA
DOXEP DOXEPIN (SINEQUAN) 80166/80299 RED - NO GEL TUBES 4.0 ML <7 days N HPLC
DASR DRUG ABUSE PANEL (12) 80101 x12 URINE RANDOM 30.0 ML <72 Hours N Immunoassay
EBVQNT EBV VIRUS DNA PCR 87798 LAV 15.0 ML 2 TUBES REQUIRED <10 days N PCR
ECHO ECHOVIRUS AB PANEL 86658 x5 SST/Gold 5.0 ML <10 days N Serum Neutralization
SHIGAB E. COLI SHIGA TOXINS 87427 STERILE CONTAINER N/A STOOL <72 Hours N EIA
LYTES ELECTROLYTE PANEL 80051 SST/Gold 2.0 ML <4 Hours Y ISE/Enzymatic
HGBELE ELECTROPHORESIS, HEMOGLOB 83020 LAV 3.0 ML PERFORMED ON TUESDAYS <10 days N Electrophorisis
EBVPAN EPSTEIN BARR VIRUS PANEL 86665 x3 SST/Gold 3.0 ML <7 days N ELISA
EBVG EPSTEIN-BARR IGG AB 86665 SST/Gold 3.0 ML <7 days N ELISA
EBVM EPSTEIN-BARR IGM AB 86665 SST/Gold 3.0 ML <7 days N ELISA
ERYTHB ERYTHROPOETIN 82668 SST/Gold 3.0 ML SEPARATE FROM CELLS ASAP. N Chemiluminescent
E2 ESTRADIOL, SERUM 82670 SST/Gold 3.0 ML <72 Hours N Electrochemiluminescent Assay
ESTSFR ESTROGENS, SERUM FRACTIONATED 82671 SST/Gold 3.0 ML <7 days N Chemiluminescent
ETHOQ ETHOSUXIMIDE (ZARONTIN) 80168 RED - NO GEL TUBES 3.0 ML <7 days N EIA
F2ACTB FACTOR II ACTIVITY 85210 BLUE - TUBE MUST BE FULL 4.5 ML <72 Hours N Clotting
F9ACTB FACTOR IX 85250 BLUE - TUBE MUST BE FULL 4.5 ML <72 Hours N Clotting
F9ABB FACTOR IX AB 85250 BLUE - TUBE MUST BE FULL 4.5 ML <72 Hours N Clotting
F5ACTB FACTOR V ACTIVITY 85220 BLUE - TUBE MUST BE FULL 4.5 ML <72 Hours N Clotting
F7ACTB FACTOR VII 85230 BLUE - TUBE MUST BE FULL 4.5 ML <72 Hours N Clotting
F8ABB FACTOR VIII AB 85240 BLUE - TUBE MUST BE FULL 4.5 ML <72 Hours N Clotting
F8ACTB FACTOR VIII ACTIVITY 85240 BLUE - TUBE MUST BE FULL 4.5 ML <72 Hours N Clotting
F8AGB FACTOR VIII AG 85244 BLUE - TUBE MUST BE FULL 4.5 ML PERFORMED ON FRIDAY <7 days N Clotting
F10ACB FACTOR X ACTIVITY 85260 BLUE - TUBE MUST BE FULL 4.5 ML <72 Hours N Clotting
F13ACB FACTOR XIII ACTIVITY 85291 BLUE - TUBE MUST BE FULL 4.5 ML <72 Hours N Clotting
F11ACB FACTOR XI ACTIVITY 85270 BLUE - TUBE MUST BE FULL 4.5 ML <72 Hours N Clotting
F12ACB FACTOR XII ACTIVITY 85280 BLUE - TUBE MUST BE FULL 4.5 ML <72 Hours N Clotting
F5BAT FACTOR-V LEIDEN 83891 LAV 5.0 ML <72 Hours N PCR
FECFAT FAT, FECAL QUANTITATIVE 82710 STOOL - 72 HR COLLECTION N/A REQUEST CONTAINER <7 days N Gravimetric
FEBAG FEBRILE AGGLUTININS 86000 SST/Gold 2.0 ML <7 days N ELISA
FELB FELBAMATE 80299 RED - NO GEL TUBES 5.0 ML <7 days N HPLC
FERRIT FERRITIN 82728 SST/Gold 2.0 ML <72 Hours N Electrochemiluminescent Assay
FFNBAT FETAL FIBRONECTIN 82731 COLLECTION KIT N/A <4 Hours Y Semi-Quant. Solid Phase/Immunosorbent
KBSTB FETAL HGB (ACID ELUTION) 85460 LAV 2.0 ML KLEIHAUER-BETKE STAIN <4 Hours Y Acid Elution
FLM FETAL LUNG MATURITY 83663 AMNIOTIC FLUID 5.0 ML <4 Hours Y FPIA
FIBRIN FIBRINOGEN, QUANTITATIVE 85384 BLUE - TUBE MUST BE FULL 4.5 ML <4 Hours Y Clotting
FKBAT FK 506 / TACROLIMUS 80197 LAV 5.0 ML <24 Hours N MEIA
FLUNI FLUNITRAZEPAM 80101 URINE RANDOM 20.0 ML <7 days N LC/MS
FOLSER FOLATE,SERUM 82746 SST/Gold 2.0 ML <72 Hours N Electrochemiluminescent Assay
PSAFTB FREE AND TOTAL PSA 84154 & 84153 SST/Gold 5.0 ML <7 days N Electrochemiluminescent Assay
PTNUNBT FREE PHENYTOIN 80186 & 80185 RED - NO GEL TUBES 3.0 ML <4 Hours Y FPIA
FRUCTO FRUCTOSAMINE 82985 SST/Gold 5.0 ML <7 days N Spectrophotemetry
FSH FSH (FOLLICAL STIM H) 83001 SST/Gold 2.0 ML <72 Hours N Electrochemiluminescent Assay
GABAP GABAPENTIN (NEURONTIN) 80299 RED - NO GEL TUBES 4.0 ML <7 days N HPLC
GGT GAMMA GT (GGT) 82977 SST/Gold 2.0 ML <4 Hours Y Enzymatic
GASTRN GASTRIN, EACH SPECIMEN 82941 SST/Gold 2.0 ML <7 days N RIA
GENTP GENTAMICIN PEAK 80170 RED - NO GEL TUBES 3.0 ML <4 Hours Y FPIA
 SQ CODE TEST NAME CPT SPECIMEN REQUIREMENTS ML NOTES TAT STAT METHOD
GENT GENTAMICIN RANDOM 80170 RED - NO GEL TUBES 3.0 ML <4 Hours Y FPIA
GENTT GENTAMICIN TROUGH 80170 RED - NO GEL TUBES 3.0 ML <4 Hours Y FPIA
GAT GIARDIA ANTIGEN 87329 STOOL 1.0 GM <72 Hours N EIA
GLUCA GLUCAGON 82943 LAV 7.0 ML <10 days N RIA
GTT1HR GLUCOSE 1HR GESTATIONAL 82950 RED OR GRAY 5.0 ML <4 Hours N Enzymatic
GTT2HR GLUCOSE TOLERANCE TEST 82947/82950 GRAY 5.0 ML DRAWN 2HRS POST 75G GLUCOLA DOSE <4 Hours N Enzymatic
GLUBFB GLUCOSE, BODY FLUID 82945 STATE SOURCE 2.0 ML <4 Hours Y Enzymatic
GLUCSF GLUCOSE, CSF 82945 CSF 1.0 ML <4 Hours Y Enzymatic
GLU GLUCOSE, SERUM 82947 SST/Gold OR GRAY 3.0 ML <4 Hours Y Enzymatic
GAD65 GLUTAMIC ACID DECARBOXYLASE 83519 SST/Gold 3.0 ML 7-14 days N Immunoradiometric Assay
HPYAGB H PYLORI AG STOOL 87338 STOOL 2.0 GM <7 days N EIA
TPPA H.A.T.T.S. (RPR) 86592 SST/Gold 3.0 ML <7 days N Flocculation
HALP HALDOPERIDOL (HALDOL) 82486 RED - NO GEL TUBES 5.0 ML <7 days N HPLC
HAPTO HAPTOGLOBIN 83010 SST/Gold 3.0 ML <72 Hours N Immunoturbidimetric
HCGUR HCG, QUALITATIVE URINE 81025 URINE RANDOM 5.0 ML <4 Hours Y Immunoassay
HPYL HELICOBACTER PYLORI AB 86677 x2 SST/Gold 2.0 ML <72 Hours N ELISA
HEMCHM HERED. HEMOCHROMATOSIS MUT. 83890 LAV 5.0 ML <10 days N PCR
A1C HEMOGLOBIN A1C (GLYCOHGB) 83036 LAV 3.0 ML <72 Hours N HPLC
HEMSID HEMOSIDERIN STAIN, URINE 83070 URINE RANDOM 5.0 ML <7 days N Microscopic Stain
HITBAT HEPARIN PLT AB 86022 BLUE - TUBE MUST BE FULL 4.5 ML <10 days N ELISA
HEPAT HEPATIC FUNCTION PANEL 80076 SST/Gold 4.0 ML <4 Hours Y Refer to Individual Components
HAVIGM HEPATITIS A IGM 86709 SST/Gold 2.0 ML SET UP TUES., REPORTS WED. <7 days N EIA
HAVTOT HEPATITIS A TOTAL 86708 SST/Gold 2.0 ML PERFORMED TUES. & THURS. <7 days N EIA
HBCIGM HEPATITIS B CORE IGM 86705 SST/Gold 2.0 ML SET UP MON., REPORTS TUES. <7 days N EIA
HBCTOT HEPATITIS B CORE TOTAL 86704 SST/Gold 2.0 ML PERFORMED MON. & WED. <7 days N EIA
HBVPCR HEPATITIS B DNA 87517 LAV 2.0 ML <10 days N PCR
HBSAB HEPATITIS B SURFACE AB 86706 SST/Gold 2.0 ML <72 Hours N EIA
HBSAG HEPATITIS B SURFACE ANTIG 87340 SST/Gold 2.0 ML <72 Hours Y Chemiluminescent
HBEAB HEPATITIS BE AB 86707 SST/Gold 2.0 ML <10 days N EIA
HBEAG HEPATITIS BE ANTIGEN 87350 SST/Gold 2.0 ML <10 days N EIA
HCV HEPATITIS C AB 86803 SST/Gold 3.0 ML PERFORMED MON., WED. & FRI. <7 days N EIA
HCVGEN HEPATITIS C GENOTYPE 87902 SST/Gold 3.0 ML 14-21 days N PCR
CRIBA HEPATITIS C RIBA 86804 SST/Gold 3.0 ML 7-14 days N RIBA
HCVQNT HEPATITIS C RNA QUANT 87522 SST/Gold 3.0 ML <7 days N bDNA
HEPDEL HEPATITIS DELTA AB 86692 SST/Gold 3.0 ML <7 days N EIA
VCHSV HERPES CULTURE 87252 VIRAL TRANSPORT N/A STATE SOURCE VARIABLE N Cell Culture
HSVFA HERPES FA 87274 SLIDE 2 <72 Hours N FA
HSVG HERPES IGG 1 & 2 86694 SST/Gold 2.0 ML <72 Hours N ELISA
HSVM HERPES IGM 1 & 2 86694 SST/Gold 2.0 ML <72 Hours N ELISA
MONO HETEROPHILE AB, MONO TEST 86308 SST/Gold 2.0 ML MONOSPOT <72 Hours Y Latex Agglutination
HEXO HEXOSAMINIDASE 83080 SST/Gold 4.0 ML <10 days N Heat Inactivation/Fluorometric
HISTU HISTAMINE 24 HR URINE 83088 24HR UR - HCL PRESERVATIVE 25.0 ML REQUEST CONTAINER <7 days N EIA
HPANT HISTOPLASMA AG 87385 URINE RANDOM 3.0 ML <7 days N EIA
HISTAB HISTOPLASMA ANTIBODY 86698 x2 SST/Gold 4.0 ML <7 days N CF
HIV12 HIV SCREEN 86703 RED - TUBE MUST BE FOR HIV ONLY 3.0 ML Reflex to HIV-1 Confirmation by Western Blot <72 Hours Y EIA
WEBLOT HIV WESTERN BLOT CONFIRM 86689 SST/Gold 3.0 ML <10 days N Western Blot
B27 HLA B27 86812 YELLOW WHOLE BLOOD ACD SOLN A 10.0 ML DO NOT REFRIGERATE <10 days N Flow Cytometry

29
 SQ CODE TEST NAME CPT SPECIMEN REQUIREMENTS ML NOTES TAT STAT METHOD

30
HOMOB HOMOCYSTEINE 83090 RED ON ICE 3.0 ML SEND IMMEDIATELY <7 days N EIA
HSVPCR HSV DNA PCR CSF 3.0 ML <7 days N PCR
HTLV12 HTLV I/II 86790 SST/Gold 3.0 ML PERFORMED THURS. <7 days N EIA
HU HU AB (NERUONAL NUCLEAR) SST/Gold 3.0 ML <10 days N EIA
HGH HUMAN GROWTH HORMONE 83003 SST/Gold 3.0 ML <7 days N Chemiluminescent
17PROG HYDROXYPREGNENOLONE (17) 84143 SST/Gold 3.0 ML <7 days N Tandem MS
17PREG HYDROXYPROGESTERONE (17) 83498 SST/Gold 3.0 ML <7 days N RIA
IMIPR IMIPRAMINE & DESIPRAMINE 80174 & 80160 RED - NO GEL TUBES 8.0 ML <7 days N HPLC
PECSF
ELECTROPHORESIS, CSF 84157 & 84166 CSF 2.0 ML PERFORMED M, W, F <7 days N Electrophoresis: Reflex to Immunifixation
Electrophoresis if Bands of restricted
mobility are present.
PEURIN
ELECTROPHORESIS, URINE 84156 & 84165 URINE RANDOM - NO PRESERVATIVE 10.0 ML PERFORMED M, W, F <7 days N Electrophoresis: Reflex to Immunifixation
Electrophoresis if Bands of restricted
mobility are present.
IMGLOB IMMUNOGLOB QUANT (A, G,M) 82784 X 3 SST/Gold 4.0 ML <72 Hours N Immunoturbidimetric
IGA IMMUNOGLOBULIN A 82784 SST/Gold 2.0 ML <72 Hours N Immunoturbidimetric
IMMDB IMMUNOGLOBULIN D 82784 SST/Gold 2.0 ML <7 days N Nephelometry
IGE IMMUNOGLOBULIN E 82785 SST/Gold 2.0 ML <72 Hours N Electrochemiluminescent Assay
IGG IMMUNOGLOBULIN G (IGG) 82784 SST/Gold 2.0 ML <72 Hours N Immunoturbidimetric
IGSUB IMMUNOGLOBULIN G (SUBCLASSES) 82787 X 4 SST/Gold 3.0 ML OVERNIGHT FASTING PREFERRED <7 days N Nephelometry
IGM IMMUNOGLOBULIN M (IGM) 82784 SST/Gold 2.0 ML <72 Hours N Immunoturbidimetric
INFLAB INFLUENZA A & B AB 86710 x 4 SST/Gold 2.0 ML <7 days N ELISA
INSULN INSULIN 83525 SST/Gold 2.0 ML <72 Hours N Electrochemiluminescent Assay
INSAA INSULIN AUTOANTIBODIES 86337 SST/Gold 2.0 ML <7 days N RIA
INTRAB INTRINSIC FACTOR BLOCKING AB 86340 SST/Gold 2.0 ML <7 days N RIA
FETIBC IRON & IRON BINDING CAPACITY 83540 & 83550 SST/Gold 4.0 ML <72 Hours N Spectrophotemetry/Calculation
FE IRON, TOTAL 83540 SST/Gold 2.0 ML <72 Hours Y Spectrophotometry
KAPLAM KAPPA LAMBDA LT CHAIN 83883 x 2 SST/Gold 2.0 ML <7 days N Immunoturbidimetric
LACTOF LACTOFERRIN (STL LEUKOCYTE DETECTION) 83630 STERILE CONTAINER N/A STOOL <72 Hours N EIA
LDH LDH (LACTIC DEHYDROGENASE) 83615 SST/Gold 2.0 ML <4 Hours Y Enzymatic
LDBFB LD, BODY FLUID 83615 STERILE CONTAINER 2.0 ML STATE SOURCE <72 Hours Y Enzymatic
LEADWB LEAD (PB), BLOOD 83655 ROYAL BLUE EDTA 3.0 ML <7 days N Inductively Coupled Plasma/MS
LEADUB LEAD (PB), URINE 83655 24 HR UR-ACID WASHED CONTAINER 10.0 ML DO NOT MEASURE URINE <7 days N Inductively Coupled Plasma/MS
LEGIGG LEGIONELLA AB, TYPE 1 IGG 86713 SST/Gold 2.0 ML <7 days N ELISA
LEGC LEGIONELLA CULTURE 87081 STERILE CONTAINER N/A STATE SOURCE VARIBLE N Culture
LAT LEGIONELLA URINARY AG 87499 URINE RANDOM - NO PRESERVATIVE 2.0 ML <7 days N Latex Agglutination
LEPTOA LEPTOSPIRA AB 86720 SST/Gold 3.0 ML <7 days N Ind. Hemagglutination
LAP LEUKOCYTE ALKALINE PHOS (LAP) 85540 GREEN 2.0 ML MUST BE RECEIVED WITHIN 8 HRS. OF COLLECTION <72 Hours N Cytochemical Stain
LH LH (LUTEINIZING HORMONE) 83002 SST/Gold 3.0 ML <72 Hours N Electrochemiluminescent Assay
LIDOCA LIDOCAINE 80176 RED 2.0 ML <7 days N FPIA
LIPA LIPASE 83690 SST/Gold OR TIGER 2.0 ML <4 Hours Y Enzymatic
LIPBFB LIPASE, BODY FLUID 83690 STERILE CONTAINER 2.0 ML STATE SOURCE <72 Hours N Enzymatic
LIPUR LIPASE, RANDOM URINE 83690 URINE RANDOM - NO PRESERVATIVE 5.0 M <7 days N Enzymatic
LIPID LIPID PROFILE 80061 SST/Gold 4.0 ML <72 Hours N Refer to Individual Components
LI LITHIUM, SERUM 80178 SST/Gold OR TIGER 3.0 ML <4 Hours Y ISE
LMWBAT LOW MOL WGT HEPARIN 85520 BLUE 2.0 ML <72 Hours N Chromogenic
LABAT LUPUS ANTICOAGULANT 85613 BLUE 3.0 ML PERFORMED ON FRIDAY <7 days N Clotting
LYME LYMES DISEASE, TOTAL AB 86618 SST/Gold 2.0 ML <72 Hours N ELISA
 SQ CODE TEST NAME CPT SPECIMEN REQUIREMENTS ML NOTES TAT STAT METHOD
MG MAGNESIUM, SERUM 83735 SST/Gold 2.0 ML <4 Hours Y Spectrophotometry
MALSMR MALARIA SMEAR 87207 LAV 2.0 ML <72 Hours N Cytochemical Stain
METAUR METANEPHRINES, URINE 83835 24 HR UR-ACID WASHED CONTAINER 10.0 ML AVOID CAFFEINE,TOBACCO, ALPHA BLOCKERS <7 days N GC/MS
MMASQB METHYLMALONIC ACID, SERUM QUANT. 83291 RED - NO GEL TUBES 4.0 ML <7 days N Tandem MS
24HMAU MICROALBUMIN, 24HR URINE 82043 & 82570 24 HR URINE - NO PRESERVATIVE 5.0 ML <7 days N Immunoturbidimetric
RANMAU MICROALBUMIN, URINE 82043 & 82570 URINE RANDOM - NO PRESERVATIVE 5.0 ML <72 Hours N Immunoturbidimetric
MSTN MICROSPORIDIA 87207 & 87015 3 VIAL KIT-STOOL N/A <72 Hours N Mod. Trichrome Stain
MSPANB MS PANEL 83916,83873,
282784X2,
82040,82042 CSF AND RED 3 ML/EACH COLLECT DATE/TIME MUST BE SAME FOR BOTH TUBES <10 days N Refer to Individual Components
MUMP MUMPS AB, IGG IGM 86735 SST/Gold 3.0 ML <7 days N
MYCOPB MYCOPLASMA PNEUMO AB (IGG/M)86738 X 2 SST/Gold 3.0 ML <7 days N ELISA
MBPB MYELIN BASIC PROTEIN 83873 CSF 2.0 ML <7 days N ELISA
MYGLOB MYOGLOBIN, URINE 83874 URINE RANDOM - NO PRESERVATIVE 3.0 ML <4 Hours Y Filtration
NEOSCR NEONATAL SCREEN (PKU) 84030 BLOOD SPOT ON CARD N/A FILL TEST CARD CIRLCE W/ FLOWING BLOOD <7 days N Filter Paper
NORTRP NORTRIPTYLINE (AVENTYL) 80182 RED - NO GEL TUBES 8.0 ML <7 days N FPIA
NTELR N-TELOPEPTIDE RANDOM URINE 82523 URINE RANDOM - NO PRESERVATIVE 5.0 M <7 days N Chemiluminescent
OSMOS OSMOLALITY, SERUM 83930 SST/Gold 2.0 ML <4 Hours Y Freezing Point
OSMOUR OSMOLALITY, URINE 83935 URINE RANDOM - NO PRESERVATIVE 2.0 ML <4 Hours Y Freezing Point
OP OVA & PARASITES 87177 & 87209 3 VIAL KIT - STOOL N/A <72 Hours N Trichrome Stain
OXU24 OXALATE,URINE 24 HR 83945 24 HR UR-ACID WASHED CONTAINER 10.0 ML <7 days N Spectrophotometry
ISLETB PANCREATIC ISLET CELL AB 86341 SST/Gold 4.0 ML <7 days N Indirect FA
PARIAB PARIETAL CELL AB 86255 SST/Gold 2.0 ML <7 days N Indirect FA
PTT PARTIAL THROMBOPLASTIN TIME (PTT) 85730 BLUE - TUBE MUST BE FULL 4.5 ML MUST BE RECEIVED IN LAB WITHIN 4 HRS. OF COLLECTION <4 Hours Y Electromagnetic Mechanical Clot Detection
PARVOA PARVOVIRUS B19 AB (IGG/M) 86747 X 2 SST/Gold 4.0 ML <7 days N ELISA
PVPCRB PARVOVIRUS B-19 DNA, PCR 87798 LAV 2.0 ML <10 days N PCR
PHBFLD PH, BODY FLUID 83986 STERILE CONTAINER 2.0 ML STATE SOURCE <4 Hours Y pH Electrode
PHURIN PH, URINE 83986 CLEAN CATCH MID STREAM URINE 2.0 ML <4 Hours Y pH Electrode
PHENO PHENOBARBITAL 80184 RED - NO GEL TUBES 2.0 ML <4 Hours Y EIA
DIL PHENYTOIN (DILANTIN) 80185 RED - NO GEL TUBES 2.0 ML <4 Hours Y EIA
ALKP PHOSPHATASE, ALKALINE 84075 SST/Gold 2.0 ML <4 Hours Y Enzymatic
PHOS PHOSPHORUS, SERUM 84100 SST/Gold 2.0 ML <4 Hours Y Spectrophotometry
PO424H PHOS URINE 24 HR 84105 24 HR UR-ACID WASHED CONTAINER 3.0 ML <72 Hours N Spectrophotometry
PHOSUR PHOSPHORUS, URINE 84105 RANDOM UR-ACID WASHED CONT. 5.0 ML <72 Hours N Spectrophotometry
PINWRM PIN WORM PREP 87172 OBTAIN COLLECTION KIT FROM LAB N/A <72 Hours N Microscopic Exam
PNEAB STREP PNEUMONIAE AB, IGG 86317X14 SST/Gold 2.0 ML PRE AND POST VACCINATION SERA RECOMMENDED <10 days N FD
CRYSYN POLARIZING CRYSTALS 89060 LAV 2.0 ML SYNOVIAL FLUID <72 Hours N Microscopic Exam
K POTASSIUM, SERUM (K) 84132 SST/Gold 2.0 ML <4 Hours Y ISE
KUR POTASSIUM, URINE 84133 24 HR OR RANDOM UR-NO PRESERV. 5.0 ML <72 Hours Y ISE
PREALB PREALBUMIN 84134 SST/Gold 2.0 ML OVERNIGHT FASTNG PREFERRED <72 Hours N Immunoturbidimetric
PRENP PRENATAL PANEL/ OBSTETRIC 86901 RED - NO GEL TUBES: 10.ML BLOOD BANK LABELING REQUIRMENTS NEED 10ML VARIABLE N Hemmaglutination
3 RED & 1 PINK TUBES
PRIMET PRIMIDONE & METABOLITE 80188 & 80184 RED - NO GEL TUBES 4.0 ML <7 days N FPIA
PROGES PROGESTERONE, SERUM 84144 SST/Gold 3.0 ML <72 Hours N Chemiluminescent
PROL PROLACTIN 84146 SST/Gold 3.0 ML <72 Hours N Electrochemiluminescent Assay
PROCBT PROCAINIMIDE & NAPA 80192 RED - NO GEL TUBES 3.0 ML <72 Hours N FPIA

31
 SQ CODE TEST NAME CPT SPECIMEN REQUIREMENTS ML NOTES TAT STAT METHOD

32
PSAUF PROSTATE SPECIFIC AG (PSA), 84153 SST/Gold 3.0 ML <72 Hours N Electrochemiluminescent Assay
SCREENING
PCACBT PROTEIN C ACTIVITY 85303 BLUE - TUBE MUST BE FULL 4.5 ML PERFORMED ON FRIDAY <10 days N Clotting
PCAGBT PROTEIN C AG 85302 BLUE - TUBE MUST BE FULL 4.5 ML <10 days N EIA
PSACBT PROTEIN S ACTIVITY 85306 BLUE - TUBE MUST BE FULL 4.5 ML PERFORMED ON FRIDAY <10 days N Clotting
PSAGB PROTEIN S AG PANEL 85305 BLUE - TUBE MUST BE FULL 4.5 ML <10 days N EIA
PESER PROTEIN ELECTROPHORESIS
84160 & 84165 SST/Gold 3.0 ML PERFORMED M, W, F <7 days N Electrophoresis: Reflex to Immunifixation
Electrophoresis if Bands of restricted
mobility are present.
PROBFB PROTEIN, BODY FLUID 84157 STATE SOURCE 1.0 ML <72 Hours Y Spectrophotometry
PROCSF PROTEIN, SPINAL FLUID 84157 CSF 1.0 ML <4 Hours Y Spectrophotometry
TP PROTEIN, TOTAL SERUM 84155 SST/Gold 2.0 ML <4 Hours Y Spectrophotometry
PROUR PROTEIN, URINE QUANTITIVE 84156 24HR UR OR URINE RANDOM 5.0 ML <72 Hours Y Spectrophotometry
PTINR PROTHROMBIN TIME (PT) 85610 BLUE - TUBE MUST BE FULL 4.5 ML <4 Hours Y Electromagnetic Mechanical Clot Detection
FLUOXB PROZAC (FLUOXETINE & METABOLITE) 80299X2 RED - NO GEL TUBES 5.0 ML <7 days N HPLC
PTMIX PT, 1-1 MIX 85611 BLUE - TUBE MUST BE FULL 4.5 ML <72 Hours Y Electromagnetic Mechanical Clot Detection
PTHINP PTH INTACT 83970 & 82310 SST/Gold 3.0 ML <72 Hours N Electrochemiluminescent Assay
PTTMIX PTT, 1-1 MIX 85732 BLUE - TUBE MUST BE FULL 4.5 ML <72 Hours Y Electromagnetic Mechanical Clot Detection
QFEVA Q FEVER AB 86638 SST/Gold 5.0 ML <7 days N IFA
QUIN QUINIDINE 80194 RED - NO GEL TUBES 2.0 ML <72 Hours Y FPIA
RAPA RAPAMYCIN 80195 LAV 5.0 ML 1–3 days N MEIA
RENPLB RENIN, PLASMA 84244 LAV ON ICE 3.0 ML SEND IMMEDIATELY <7 days N RIA
REPTCB REPTILASE CLOTTING TIME 85635 BLUE - TUBE MUST BE FULL 4.5 ML <7 days N Clotting
RETIC RETICULOCYTE COUNT 85045 LAV 3.0 ML <4 Hours Y Cytochemical Stain
RHEUF RHEUMATOID FACTOR, QUANT 86431 SST/Gold 2.0 ML <72 Hours N Immunoturbidimetric
RHOG RHOGAM CANDIDATE 86901 RED & WHOLE BLOOD / PINK 3.0 ML NOTE LABELING REQUIREMENTS - NO EXCEPTIONS <72 Hours Y Hemagglutination
RMSFAB ROCKY MOUNTAIN SPOTTED FEVER 86757 X 2 SST/Gold 10.0 ML <7 days N ELISA
VWACTB VON WILLEBRAND ACTIVITY 85245 BLUE - TUBE MUST BE FULL 4.5 ML <7 days N Platelet Agglutination
ROTAV ROTAVIRUS ANTIGEN 87425 STOOL 2.0GM <72 Hours N EIA
RPR RPR, SERUM 86592 SST/Gold 3.0 ML <72 Hours N Flocculation
RSVAG RSV 87280 VIRAL TRANSPORT MEDIA N/A <72 Hours N ELISA
RSVFA RSV-FA 87280 SLIDE N/A <72 Hours N DFA
RUBG RUBELLA IGG 86317 SST/Gold 2.0 ML <72 Hours N ELISA
RUBIGM RUBELLA IGM 86762 SST/Gold 2.0 ML <7 days N Chemiluminescent
RUBEOG RUBEOLA AB, IGG (MEASLES) 86765 SST/Gold 2.0 ML <72 Hours N ELISA
RUBEMB RUBEOLA AB, IGM (MEASLES) 86765 SST/Gold 2.0 ML <7 days N ELISA
SALI SALICYLATE 80196 RED - NO GEL TUBES 2.0 ML <4 Hours Y FPIA
SCL70 SCLERODERMA AB SCL 70 (ENA) 86235 SST/Gold 3.0 ML RECEIVE IN LAB WITHIN 4 HRS. OF COLLECTION <7 days N Multi-Analyte FD
ESR SEDIMENTATION RATE (ESR) 85651 LAV 5.0 ML <4 Hours Y Westergren
SEROTB SEROTONIN, SERUM 84260 RED 5.0 ML <7 days N HPLC
SICKLE SICKLE CELL PREP 85660 LAV 3.0 ML <4 Hours Y Solubility
SMRNP SJOGRENS AB A&B (SMRNP) 86235 SST/Gold 3.0 ML <7 days N ELISA
CSSTN CRYPTOSPORIDIUM STAIN 87015 & 87206 STOOL 1.0 GM <72 Hours N Concentration/Modified Acid-Fast Stain
GRAMST SMEAR - GRAM STAIN 87205 STATE SOURCE-STERILE CONTAINER N/A <4 Hours Y Stain/Microscopic Exam
INK INDIA INK PREP 87210 CSF ONLY 0.5 ML <4 Hours Y India Ink Microscopic Exam
ASMA SMOOTH MUSCLE AB 86256 SST/Gold 2.0 ML <72 Hours N ELISA
NA SODIUM, SERUM (NA) 84295 SST/Gold 2.0 ML <4 Hours Y ISE
 SQ CODE TEST NAME CPT SPECIMEN REQUIREMENTS ML NOTES TAT STAT METHOD
NAUR SODIUM, URINE 84300 URINE RANDOM 2.0 ML <72 Hours Y ISE
SOMATC SOMATOMEDIN C (IGF1) 84305 SST/Gold 6.0 ML 7-14 days N Chemiluminescent
SGRBFB SPECIFIC GRAVITY, BODY FL 81002 STATE SOURCE 2.0 ML <4 Hours Y Refractometer
SPGUR SPECIFIC GRAVITY, URINE 81002 URINE RANDOM 2.0 ML <4 Hours Y Refractometer
HAMBAT ACID HEMOLYSIS (HAMS) 85475 PURPLE - TUBE MUST BE FULL 4.5 ML <7 days N Hemolysis
CD48 CD4/CD8 RATIO (T-CELL SUBSET) 86359 & 86360 LAV 5.0ML <10 days N Flow Cytometry
T3 T3 TOTAL 84480 SST/Gold 2.0 ML <72 Hours N Electrochemiluminescent Assay
FT4 T4, FREE 84439 SST/Gold 2.0 ML <72 Hours Y Electrochemiluminescent Assay
TESTFB TESTOSTERONE, FREE & TOTAL 84403 & 84270 SST/Gold 5.0 ML <7 days N Electrochemiluminescent Assay
TESTOS TESTOSTERONE, TOTAL 84403 SST/Gold 2.0 ML <72 Hours N Electrochemiluminescent Assay
TETNUB TETANUS ANTIBODIES 86317 SST/Gold 2.0 ML <10 days N Multi-Analyte FD
THEO THEOPHYLLINE 80198 RED - NO GEL TUBES 2.0 ML <4 Hours Y FPIA
THIOT THIOTHIXENE (NAVANE) 80299 RED - NO GEL TUBES 10.0 ML <7 days N HPLC
TT THROMBIN TIME 85670 BLUE - TUBE MUST BE FULL 4.5 ML <72 Hours Y Clotting
THRO THYROGLOBULIN 84432 & 86800 SST/Gold 5.0 ML <7 days N Chemiluminescent
TBGL THYROXINE BINDING GLOBULIN 84442 SST/Gold 3.0 ML <7 days N Chemiluminescent
TTAIGG TISSUE TRANS GLUTAMINASE 83516 SST/Gold 4.0 ML REPLACES ENDOMYSIAL AB <7 days N ELISA
TOB TOBRAMYCIN RANDOM 80200 RED - NO GEL TUBES 2.0 ML <4 Hours Y FPIA
TOBP TOBRAMYCIN, PEAK 80200 RED - NO GEL TUBES 2.0 ML <4 Hours Y FPIA
TOBT TOBRAMYCIN, TROUGH 80200 RED - NO GEL TUBES 2.0 ML <4 Hours Y FPIA
TOPIR TOPIRAMATE 80201 RED - NO GEL TUBES 4.0 ML <7 days N FPIA
REDUC TOTAL REDUCING SUB,STOOL 84376 STOOL 2.0 GM <72 Hours N Colorimetry
TOXOG TOXOPLASMA IGG 86317 SST/Gold 2.0 ML <7 days N ELISA
TOXOM TOXOPLASMA IGM 86778 SST/Gold 2.0 ML <7 days N ELISA
TRF TRANSFERRIN 84466 SST/Gold 3.0 ML <72 Hours N Immunoturbidimetric
TRAZO TRAZODONE (DESYRL) 80299 RED - NO GEL TUBES 3.0 ML <7 days N HPLC
TRISCR TRI SCREEN 82105, 84702, SST/Gold 15.0 ML MUST SUBMIT COMPLETED PATIENT HISTORY FORM <10 days N Multiple
82677
TRIG TRIGLYCERIDES 84478 SST/Gold 2.0 ML <72 Hours Y Enzymatic
TRGBFB TRIGLYCERIDES, BODY FLD 84478 STATE SOURCE 2.0 ML <72 Hours Y Enzymatic
TROPT TROPONIN T 84484 SST/Gold 3.0 ML <4 Hours Y Electrochemiluminescent Assay
TSH TSH (HIGHLY SENSITIVE) 84443 SST/Gold 2.0 ML <72 Hours Y Electrochemiluminescent Assay
TSC TYPE AND SCREEN 86900, 86901, PINK 7.0 ML NOTE LABELING REQUIREMENTS - NO EXCEPTIONS <72 Hours Y Hemagglutination
86850
UREBFB UREA NITROGEN BODY FLUID 84520 STATE SOURCE 2.0 ML <4 Hours Y Spectrophotometry
BUN UREA NITROGEN, SERUM (BUN) 84520 SST/Gold 2.0 ML <4 Hours Y Spectrophotometry
UNURI UREA NITROGEN, URINE 84540 URINE RANDOM 3.0 ML <4 Hours Y Spectrophotometry
UREACL UREA NITROGRN CLEARANCE 84520 & 84540 24HR UR - PLAIN / REFRIGERATE 5.0 ML REQUEST CONTAINER- NOTE: BLOOD MUST BE <72 Hours Y Spectrophotometry
COLLECTED WITHIN 24 HOUR URINE COLLECTION
URIC URIC ACID (SERUM/PLASMA) 84550 SST/Gold 2.0 ML <4 Hours Y Spectrophotometry
URICUR URIC ACID (URINE) 84560 URINE RANDOM 5.0 ML <72 Hours N Spectrophotometry
URCU24 URIC ACID (URINE 24 HR) 84560 24HR UR - PLAIN / REFRIGERATE 25.0 ML <72 Hours N Spectrophotometry
URCBFB URIC ACID, BODY FLUID 84560 STATE SOURCE 2.0 ML <72 Hours N Spectrophotometry
URINAL URINALYSIS, ROUTINE 81001 URINE RANDOM 10.0 ML <4 Hours Y Reflective Photometry/Microscopy by Yellow IRIS
VAGBSS VAGINAL BSS 87081 STERILE CONTAINER N/A STATE SOURCE 2-3 days N Standardture SOP for Aerobic
Bacterial Culture & ID
VALP VALPROIC ACID (DEPAKENE) 80164 RED - NO GEL TUBES 3.0 ML <4 Hours Y FPIA
VNPBT VANCOMYCIN, PEAK 80202 RED - NO GEL TUBES 3.0 ML <4 Hours Y FPIA

33
 SQ CODE TEST NAME CPT SPECIMEN REQUIREMENTS ML NOTES TAT STAT METHOD

34
VNRBAT VANCOMYCIN, RANDOM 80202 RED - NO GEL TUBES 3.0 ML <4 Hours Y FPIA
VNTBAT VANCOMYCIN, TROUGH 80202 RED - NO GEL TUBES 3.0 ML <4 Hours Y FPIA
VMA24U VANILLYMANDELIC ACID (VMA) 84585 24HR UR - HCL PRESERVATIVE 25.0 ML <7 days N HPLC
VZG VARICELLA ZOSTER AB IGG 86787 SST/Gold 3.0 ML <7 days N ELISA
VZFA VARICELLA ZOSTER FA 87290 SLIDE N/A <72 Hours N DFA
VZMB VARICELLA ZOSTER, IGM 86787 SST/Gold 3.0 ML <7 days N ELISA
VIPB VASO INTESTINAL POLYPEPTIDE 84586 LAV 5.0 ML <10 days N RIA
VDRL VDRL CSF 86592 CSF 2.0 ML <72 Hours N Flocculation
VCASP VIRAL CULT - ASPIRATE 87252 VIRAL TRANSPORT MEDIA N/A STATE SOURCE VARIABLE N Cell Culture
VCAUT VIRAL CULT - AUTOPSY 87252 VIRAL TRANSPORT MEDIA N/A STATE SOURCE VARIABLE N Cell Culture
VCBM VIRAL CULT - BM 87252 VIRAL TRANSPORT MEDIA N/A STATE SOURCE VARIABLE N Cell Culture
VCBX VIRAL CULT - BX 87252 VIRAL TRANSPORT MEDIA N/A STATE SOURCE VARIABLE N Cell Culture
VCCSF VIRAL CULT - CSF 87252 CSF CONTAINER N/A VARIABLE N Cell Culture
VCEYE VIRAL CULT - EYE 87252 VIRAL TRANSPORT MEDIA N/A STATE SOURCE VARIABLE N Cell Culture
VCGEN VIRAL CULT - GENITAL 87252 VIRAL TRANSPORT MEDIA N/A STATE SOURCE VARIABLE N Cell Culture
VCHSV VIRAL CULT - HSV 87252 VIRAL TRANSPORT MEDIA N/A STATE SOURCE VARIABLE N Cell Culture
VCLES VIRAL CULT - LESION 87252 VIRAL TRANSPORT MEDIA N/A STATE SOURCE VARIABLE N Cell Culture
VCRESP VIRAL CULT - RESP 87252 VIRAL TRANSPORT MEDIA N/A STATE SOURCE VARIABLE N Cell Culture
VCSTL VIRAL CULT - STOOL 87252 VIRAL TRANSPORT MEDIA N/A STATE SOURCE VARIABLE N Cell Culture
VCUR VIRAL CULT - URINE 87252 STERILE URINE CONTAINER N/A STATE SOURCE VARIABLE N Cell Culture
VISCSS VISCOSITY SERUM 85810 RED 10.0 ML <7 days N Cone-Plate Viscometer
VITABA VITAMIN A 84590 GREEN 3.0 ML PROTECT FROM LIGHT <7 days N HPLC
B12 VITAMIN B-12 82607 SST/Gold 3.0 ML <72 Hours N Electrochemiluminescent Assay
VITACB VITAMIN C 82180 GREEN 5.0 ML CRITICAL FROZEN <7 days N Spectrophotometry
VITD25 VITAMIN D 25 HYDROXY 82306 SST/Gold 3.0 ML <7 days N Chemiluminescent
VITEB VITAMIN E 84446 GREEN 5.0 ML PROTECT FROM LIGHT <7 days N HPLC
VITAK VITAMIN K 84597 SST/Gold 5.0 ML PROTECT FROM LIGHT 7-14 days N HPLC
VWMBAT VON WILLEBRAND MULTIMER 85247 BLUE - TUBE MUST BE FULL 4.5 ML <10 days N Clotting
F8AGB VON WILLEBRAND’S FACTOR (VWF AG) 85246 BLUE - TUBE MUST BE FULL 4.5 ML <10 days N Chromogenic
ZNFEP ZINC PROTOPHORPHYRIN 84202 ROYAL BLUE EDTA 3.0 ML PROTECT FROM LIGHT <7 days N Hematofluorometry
ZN24UR ZINC, 24 HR URINE 84630 24HR UR - PLAIN / REFRIGERATE 25.0 ML REQUEST CONTAINER <7 days N Inductively Coupled Plasma/MS
ZINCS ZINC, SERUM 84630 ROYAL BLUE, NO ADDITIVE 3.0 ML <7 days N Inductively Coupled Plasma/MS
 Map to
Rocky Point Lab
Gainesville, Florida


Shands
at UF

United
States
Post
Office
To
Archer
SW 47th Avenue Road

SW 35th Drive
Rocky Point Lab
4800 SW 35th Drive

SW 34th Street
Entrance

U
Exit
382
75 Parking
Nationwide
Exit
382 Publix

Williston Road (SR 331)

13th Street
(US Hwy 441)

Rocky Point Lab Phone: 352.265.0172

4800 SW 35th Drive Fax: 352.265.9910
Gainesville, FL 32608 Hours: 7 am – 5 pm, M – F

DRIVING DIRECTIONS
From Archer Road (near I-75 interchange) From 13th Street/US Hwy 441
1 Travel east on Archer Road to 34th Street. 1 Turn west onto Williston Road (SR 331).
2 Turn right onto SW 34th Street heading south. 2 Turn right onto SW 34th Street heading north.
3 Turn right onto 47th Avenue heading west. 3 Turn left onto 47th Avenue heading west.
4 Turn left onto SW 35th Drive heading south. 4 Turn left onto SW 35th Drive heading south.
The lab is just south of the 34th Street Post Office. The lab is just south of the 34th Street Post Office.

From I-75
1 Take Exit 382 to Williston Road (SR 331).
2 Turn left onto Williston Road (SR 331) heading east.
3 Turn left onto SW 34th Street heading north.
4 Turn left onto 47th Avenue heading west.
5 Turn left onto SW 35th Drive heading south. 3/22/06
The lab is just south of the 34th Street Post Office. PS64498
 Draw Stations
F
Magnolia 441
Parke
75
Shands Vista
24 Gainesville
Shands Rehab Hospital
Regional Airport
222 39TH AVENUE 39TH AVENUE
Exit #390

NW 13TH STREET
Crown
23RD AVENUE 16TH BLV
Pointe
D 16TH AVENUE

43RD ST

34TH ST

D
OA
Exit #387

OR
LD
26 NE
8TH AVENUE

WA
MAIN STREET
WB Park Avenue UF Shands Eastside
Tower Hill ER Community Practice
Internal Oaks RY R
OA
SW

Mall D
Medicine
26
62N

UNIVERSITY AVENUE UNIVERSITY AVENUE

A
D ST

West UF Orthopaedics
75TH STREET (TOWER ROAD)

Oaks and Sports SW 2ND AVE 20

SW 6
2 N
Medicine
Institute HA
D BLVD

WT
HOR
16TH AVENUE NE
SW 20TH AVENUE RO
AD
Shands at UF

ET
TRE
Shands D
AD
IN S
RO
Medical Ayers
Family
91ST STREET

R Plaza MA
C HE Practice Medical Plaza
Haile AR 121
C and Surgery
91ST TERRACE

Plantation Rocky Medical

331 Group Center
Exit #384 Point
VD) AD
E
SW 13TH STREET

AILE BL B RO
46TH BLVD (H N
O
75 IST Shands
24 ILL
W Florida
AD Surgical
RR
O Exit #382
C HE Center
AR
121
441

Map not to scale.

Tower Hill Internal Medicine Shands at UF Outpatient Laboratory*

A 7540 W. University Ave.
D First Floor of Shands at UF (Room 1021.1)
Gainesville, FL 32607 1600 SW Archer Rd.
352.265.0370 Gainesville, FL 32610
Open 8 am – 4:30 pm, Monday – Friday 352.265.0484
Closed 12:30 pm –1:30 pm for lunch Open 6 am – 5:30 pm, Monday – Friday

Shands at Rocky Point Ayers Diagnostic Lab

B 4800 SW 35th Dr.
E 720 SW 2nd Ave.
Gainesville, FL 32608 Gainesville, FL 32601
352.265.0522 352.338.2109
Open 7 am – 5 pm, Monday – Friday Open 7:30 am – 4 pm, Monday – Friday

Shands Medical Plaza* Lab Draw Station and

C 2000 SW Archer Rd.
F Magnolia Parke Sleep Disorders Clinic
Gainesville, FL 32609 4740 SW 39th Pl., Suite B
352.265.0111, x 87175 Gainesville, FL 32606
Open 7:30 am – 5:30 pm, Monday – Friday 352.265.5240
Open 7:30 am – 4 pm, Monday – Friday

Rev. 10/23/09 *$3 parking fee at these locations. PS43541

 SEND TO:
Cytology � SHANDS MEDICAL LABORATORIES AT ROCKY POINT � SHANDS AT THE UNIVERSITY OF FLORIDA � SHANDS AGH

Medical Laboratories Request 4800 SW 35th Drive • Gainesville, FL 32608 1600 SW Archer Road • Gainesville, FL 32608 801 SW 2nd Ave. • Gainesville, FL 32601
(352) 265-0522 • Fax: (352) 265-9910 (352) 265-0208 • Fax: (352) 338-9889 (352) 733-0256 • Fax: (352) 733-0259
CLIENT INFORMATION – REFERRING PHYSICIAN (PLEASE PRINT IN BLACK INK) PATIENT INFORMATION
PT LAST NAME FIRST MI

ADDRESS BIRTHDATE SEX: � M � F

CITY PT SSN

STATE ZIP HOME PHONE

EMPLOYER WORK PHONE

REFERRING PHYSICIAN SIGNATURE

WORK ADDRESS CITY STATE ZIP
INSURANCE BILLING INFORMATION (PLEASE PRINT IN BLACK INK)
PRIMARY: � Medicare � Medicaid � Other Ins. � Self � Spouse � Dependent
SUBSCRIBER LAST NAME FIRST MI
COLLECTION REPORTING INFORMATION
� FAX results to � COPY to
� CALL results to
BENEFICIARY/MEMBER # GROUP #
Date Collected � Non-Fasting Time Collected � AM � PM
� Fasting (8hrs)
CLAIMS ADDRESS CITY STATE ZIP
For Lab Use Only

SECONDARY: � Medicare � Medicaid � Other Ins. � Self � Spouse � Dependent

� Signed ABN Obtained STAT
SUBSCRIBER LAST NAME FIRST MI

BENEFICIARY/MEMBER # GROUP # Place

Label
CLAIMS ADDRESS CITY STATE ZIP
Here

GYN SPECIMEN GYN REQUIRED MEDICAL NECESSITY INFORMATION

(1) Anatomical Source(s): SCREENING PAP
� Cervix/Endocervix � Vagina � Vaginal cuff � Other ________________________ � V76.2 Routine cervical PAP smear without gyn exam **
� V72.31 Annual/Routine PAP smear with gyn exam **
(2) Clinical History: Last Pap_______________ LMP________________ � V72.32 Follow-up of normal PAP with history of previous abnormal
� V76.47 Routine PAP smear-vagina (patient w/out cervix) **
Clinical Hx: � Pregnant � Laser Treatment � V22.1 Supervision of normal pregnancy, other
� Abnormal Bleeding � Previous Radiation � LEEP � V22.0 Supervision of normal first pregnancy
� Bilat Tubal Ligation � Other:_______________ � Radiation Therapy � V22.2 Pregnancy, incidental, NOS
� High Risk � V15.89 Childbearing age & abnormality during any of preceding 3 years, or evidence patient is at
� Hysterectomy Clinical Procedure Drugs/Hormones high risk developing cervical or vaginal cancer
� V73.81 Screening exam for HPV
� IUD � Biopsy � Birth Control Pills � V73.88 Screening exam for Chlamydial disease
� Oophorectomy � Chemotherapy � Estrogen � V74.5 Screening - sexually transmitted disease (NG)
� Post or Menopausal � Colposcopy � Progesterone ** Must obtain Advance Beneficiary Notice for Medicare patients
� Postmenopausal Bleed � Conization � Depo Provera
DIAGNOSTIC PAP
� Postpartum � Cryosurgery � Other: ________________________ � 622.10 Unspecified dysplasia of cervix
(3) Reason for Pap Smear (please select only one): � 622.11 Mild dysplasia of cervix
� 622.12 Moderate dysplasia of cervix, CIN 2
� Routine Screening � Follow-up of Abnormal Pap Test (Diagnostic) � 233.1 Severe dysplasia, carcinoma in-situ, CIN 3
Previous PAP � 623.0 Dysplasia of vagina, VAIN 1 & 2
� ASCUS � Low Grade SIL � Reactive/Reparative � 616.10 Vaginitis & vulvovaginitis, unspecified
� 616.0 Cervicitis and endocervicitis
� Carcinoma � High Grade SIL � History of AGUS � 627.3 Postmenopausal atrophic vaginitis
� 626.8 Other disorders of menstruation and other abnormal bleeding
(4) Specimen Preparation (please select only one): � 627.1 Postmenopausal bleeding
� Slide from spatula and/or brush � ThinPrep � 626.6 Metrorrhagia
� HPV Only (swab) � Other ____________________________________ � 626.2 Excessive or frequent bleeding

Previous nonspecific abnormal PAP test of cervix

(5) HPV Testing (please select only one): � 795.00 Abnormal glandular cells (AGC-NOS)
� HPV only � 795.03 Low grade intraepithelial lesion (LSIL)
� HPV reflex for ASC-US age 20 and over � 795.01 Atypical squamous cells (ASC-US)
� 795.04 High grade intraepithelial lesion (HSIL)
� HPV concurrent age 30 and over � 795.02 Atypical squamous cells not excluding high grade squamous intraepithelial lesion (ASC-H)
� HPV concurrent under the age of 30 (insurance may not cover)*** � 795.05 Cervical high risk HPV DNA positive
� HPV declined � 795.09 Atypical squamous cells and low risk HPV pos
� 795.06 Papanicolaou smear of cervix w/cytologic evidence of malignancy
***Advanced Beneficiary Notice suggested
Previous Malignant Neoplasm
� 180.9 Malignant neoplasm of cervix
(6) Infectious Disease Testing (select if applicable): � 182.0 Malignant neoplasm of uterus, corpus uteri
� N. Gonorrhea (NAT) Nucleic Acid Test � 183.0 Malignant neoplasm of ovary
� Chlamydia Trachomatis (NAT) Nucleic Acid Test � 184.4 Malignant neoplasm of vulva
Source: See reverse side for additional codes
� Liquid base PAP � Urine � Swab � ______ Other (fill in ICD-9 code)

NOTE: Please refer to Journal of Lower Genital Tract Disease 2007; 11(4):201-222 OR AJOG 2007; 348-355; for guidelines on testing for HPV. HPV testing is not recommended if the test is ASCUS favor high-grade
squamous lesion (ASC-H), LSIL, HSIL, AGC-US, or carcinoma. You may also visit www.asccp.org for additional information.
Label specimen container with patient’s name, MRN# or DOB, and site of specimen.

PHYSICIAN When ordering tests, the physician is required to make an independent medical necessity decision with regard to each test the laboratory will bill. The physician also understands he or she is
NOTICE required to (1) submit ICD-9 diagnosis supported in the patient’s medical record as documentation of the medical necessity or (2) explain and have the patient sign an ABN.
ICD-9 Code(s) Diagnosis: 1) ________________________________________ 2)__________________________ 3) ________________________________ 4) ________________________________ 5)______________________________________ 6)________________________

SIGNS AND SYMPTOMS:

NON-GYN CYTOLOGY - Label specimen container c Pt. Name, MRN or DOB & Site of specimen
� CMV � Oil Red � Fe � PCP � Fungus � Other

Clinical Hx:

REV. 04/17/2008 PS40994

RETURN WITH SPECIMEN

 Send h Shands Medical Laboratories at Rocky Point
To: 4800 SW 35th Drive • Gainesville, FL 32608

*OO0001*
Phone: (352) 265-0522 • Fax (352) 265-9910
h Shands at the University of Florida
1600 SW Archer Road • PO Box 100344 • Gainesville, FL 32610-0344
OO0001 Phone: (352) 265-0412 • Fax (352) 265-0328
CLIENT INFORMATION – REFERRING PHYSICIAN (PLEASE PRINT IN BLACK INK) PATIENT INFORMATION
PT LAST NAME FIRST MI

MEDICAL ACCOUNT #
RECORD #
ADDRESS BIRTHDATE SEX: h M h F

CITY PT SSN

STATE             ZIP HOME PHONE

EMPLOYER WORK PHONE

REFERRING PHYSICIAN SIGNATURE
WORK ADDRESS CITY          STATE   ZIP
INSURANCE BILLING INFORMATION (PLEASE PRINT IN BLACK INK)
PRIMARY: h Medicare h Medicaid h Other Ins. h Self h Spouse h Dependent PT LOCATION / CLINIC
SUBSCRIBER FIRST MI
LAST NAME
BENEFICIARY/ GROUP # COLLECTION REPORTING INFORMATION
MEMBER # h FAX results to □ COPY to
CLAIMS ADDRESS CITY          STATE   ZIP
h CALL results to
Date Collected h Non-Fasting Time Collected h AM h PM
SECONDARY: h Medicare h Medicaid h Other Ins. h Self h Spouse h Dependent
h Fasting (8hrs)
SUBSCRIBER FIRST MI
For Lab Use Only Place
LAST NAME
BENEFICIARY/ GROUP # h Signed ABN Obtained h STAT
MEMBER # h Venipuncture Draw Fee Label
CLAIMS ADDRESS CITY          STATE   ZIP
Phlebotomist Initials Here
PHYSICIAN When ordering tests, the physician is required to make an independent medical necessity decision with regard to each test the laboratory will bill. The physician also understands he or she is required
NOTICE to (1) submit ICD-9 diagnosis supported in the patient’s medical record as documentation of the medical necessity or (2) explain and have the patient sign an ABN.

ICD-9 Code(s) Diagnosis: 1) _____________________ 2) _____________________ 3) _____________________ 4) _____________________ 5) _____________________ 6) _____________________

SIGNS AND SYMPTOMS:
ORGAN / DISEASE PANELS GENERAL LABORATORY GENERAL LABORATORY MICROBIOLOGY
□ Basic Metabolic Panel □ ANA (titer if indicated) PSA Screening (see Medicare Screening Box) □ Culture, Herpes
(Na, K, Cl, CO2, Gluc, BUN, Creat, Ca) □ Bilirubin, Direct □ PT/INR (85610) □ Culture, Sputum w/ gram stain
□ Comp. Metabolic Panel □ Bilirubin, Neonatal □ PTH, Intact (Includes CA) (83970) □ Culture, Stool
(Na, K, Cl, CO2, Gluc, BUN, Creat, Ca, □ Bilirubin, Total □ PTT (85730) (w/Campy, Sal/Shig, E. Coli, and Yersinia)
Alb, TBili, APhos, TP, AST, ALT) □ BNP (B-type Natriuetic Peptide) (83880) □ Retic Count □ Beta-Strep Screen, Throat
□ Electrolyte Panel □ CA 125 (86304) □ Rheumatoid Arthritis (RA), quant. □ Culture, Urine (87088) □ Clean Catch □ Cath
(Na, K, Cl, CO2) □ CA 19-9 (86301) □ RPR (w/confirmation if indicated) □ Culture, Wound w/gram stain
□ Hepatic Function Panel □ CA 27-29 (86300) □ Sed Rate (ESR) (85652) □ Culture, Wound Anaerobic w/gram
(Alb, TBili, DBili, APhos, TP, AST, ALT) □ Calcium (82310) □ Sickle Cell □ HGB Electrophoresis Source / Site ___________________
□ Lipid Panel (80061) □ Carbamazepine (Tegretol) □ T3, Total (84479) □ Chlamydia Probe
(Chol, Trig, HDL , calc. LDL) □ Carbon Dioxide (CO2) □ T4, Free (Free Thyroxine) (84439) □ Chlamydia / GC Probe
□ Acute Hepatitis Panel (80074) □ CBC (w/PLT & Differential) (85025) □ Transferrin (84466) Source / Site ___________________
(HAAb (IGM), HBcAB (IGM), HBsAG, HCAb) □ CBC (Hemogram w/o Differential) (85027) □ Triglycerides (84478) □ Gram Stain (only)
□ Renal Function Panel □ CCP Antibody □ TSH (Ultrasensitive) (84443)
□ CEA (82378) □ Uric Acid STOOL (FECAL)
(Na, K, Cl, CO2, Gluc, BUN, Creat, Ca, Alb, PO4)
□ Obstetric Panel (non-Medicare) □ Cholesterol (82465) □ Valproic Acid □ C-Difficile
(CBC a/plt & diff., HBSAg, Rubella, RPR, □ CK (CPK) □ Vitamin B12 □ Giardia Ag
Blood Type, Antby scr) □ CRP (High Sensitivity) □ H. Pylori Ag
□ Digoxin (Lanoxin) (80162) MICROBIOLOGY
□ Occult Blood (single specimen) (82272)
MEDICARE SCREENING (ABN REQUIRED) □ Dilantin (Phenytoin) (Culture ID & Sensitivity if indicated) □ Ova & Parasite
□ Ferritin (82728)
□ Cardiovascular Screen □ Folate, Serum URINE
Collection Date _______ Time _______
(Includes: Cholesterol, Triglycerides and □ GGT (82977)
HDL Freq., Covered every 5 years (ABN □ Culture, AFB sputum w/smear
□ Glucose, Serum (82947) □ Culture, AFB other w/smear □ Creatinine Clearance
Required) □ Glucose Tolerance ______ hrs □ Microalbumin, Urine (Check one below)
Dx – Requires one (1) of the Dx listed below: □ Culture, Body Fluid w/gram stain
□ H. Pylori Ab, IgG (Serum) □ Random w/creat. ratio
□ V81.0 Screening for Ischemic Heart Disease □ HCG, Qual. Source / Site ______________________ □ UR 24 hour
□ V81.1 Screening for Hypertension □ HCG, Quant. (84702) □ Culture, Fungus □ Protein, Total Quant.
□ V81.2 Screening for Unspecified Cardio. Conditions □ HDL (83718) □ Culture, GC  □ Vag □ Cervix □ Urinalysis (w/microscopic)
□ Diabetic Screen (Check one below) □ Hepatitis A Virus, IGM Ab □ Culture, Genital  □ Vag □ Cervix □
□ Fasting glucose and 2hr post-glucose □ Hepatitis B Core Ab □ Culture, Grp. B Strep □ Vag □ Rectal □
□ Glucose Tol. Test (3 spec. incl. fasting) □ Hepatitis B Surface Ab (86706)
Freq. – Individ. w/pre-diabetes – Twice yearly; □ Hepatitis B Surface Ag (w/conf. if positive) (87340) MISCELLANEOUS TESTS
Individ. w/o diag. pre-diabetes – Once yearly □ Hepatitis C Antibody (w/conf. if positive) (86803)
□ Dx – V77.1 Screening for Diabetes Mellitus □ Hgb A1C (glycohemaglobin) (83036)
□ HIV-1/HIV-2 Ab (w/conf.) (86703**)
□ Occult Blood Screen (1-3 specimens) □ Homocystine (Serum)
Freq. – Covered Annually (ABN Required) □ Insulin
(82272) □ Iron Bind. Capacity (inc. Iron) (83540)
□ PSA Screen (G0103) □ LDL, Direct
Freq. – Covered Annually (ABN Required) □ Lipase
□ Dx – V76.44 Scrn. for Malig. Neoplas., Prostate) □ Luteinizing Hormone (LH)
□ Magnesium (83735)
GENERAL LABORATORY □ Mono Test
□ ABO & Rh □ Phosphorus (84100)
□ AFP (Alpha Fetoprotein) (82105) □ Potassium
□ AFP Quad Screen □ Protein, Electrophoresis, Serum (SPEP)
□ Amylase □ PSA, Diagnostic (84153)
Rev. 1/16/09 **HIV Consent Required PS42510
 Surgical Pathology Request
h Shands Medical Laboratories at Rocky Point h Shands at the University of Florida h Shands AGH
Send 4800 SW 35th Drive • Gainesville, FL 32608 1600 SW Archer Road • PO Box 100344 • Gainesville, FL 32610-0344 801 SW 2nd Avenue • Gainesville, FL 32601
To: Phone: (352) 265-0111 x 72118 • Fax (352) 265-6935 Phone: (352) 265-0208 • Fax (352) 338-9889 Phone: (352) 338-6740 • Fax (352) 338-6715
CLIENT INFORMATION – REFERRING PHYSICIAN (PLEASE PRINT IN BLACK INK) PATIENT INFORMATION
PT LAST NAME FIRST MI

ADDRESS BIRTHDATE SEX: h M h F

CITY PT SSN

STATE ZIP HOME PHONE

REFERRING PHYSICIAN EMPLOYER WORK PHONE

INSURANCE BILLING INFORMATION – REFERRING PHYSICIAN (PLEASE PRINT IN BLACK INK)

PRIMARY: h Medicare h Medicaid h Other Ins. h Self h Spouse h Dependent WORK ADDRESS CITY STATE ZIP
SUBSCRIBER LAST NAME    FIRST MI

COLLECTION REPORTING INFORMATION

BENEFICIARY/MEMBER #    GROUP #
h FAX results to h COPY to

h CALL results to
CLAIMS ADDRESS    CITY STATE ZIP
Date Collected     h Non fasting Time Collected h AM h PM
    h Fasting (8 hrs)
SECONDARY: h Medicare h Medicaid h Other Ins. h Self h Spouse h Dependent
SUBSCRIBER LAST NAME    FIRST MI For Lab Use Only
h Signed ABN Obtained
h STAT
BENEFICIARY/MEMBER #    GROUP #
h Venipuncture Draw Fee Place

Phlebotomist Initials Label

CLAIMS ADDRESS    CITY STATE ZIP
Here

PHYSICIAN When ordering tests, the physician is required to make an independent medical necessity decision with regard to each test the laboratory will bill. The physician also understands he or she is required
NOTICE to (1) submit ICD-9 diagnosis supported in the patient’s medical record as documentation of the medical necessity or (2) explain and have the patient sign an ABN.

ICD-9 Code(s) Diagnosis: 1) ________________________ 2) ________________________ 3) ________________________ 4) ________________________ 5) ________________________ 6) ________________________

I hereby authorize any holder of medical or other information about me to release to the Social Security Administration or its intermediaries or carriers any information needed for this or a related Medicare / Medicaid
claim. I permit a copy of this authorization to be used in place of the original and request payment of medical insurance benefits to the party who accepts assignment.

X Patient Signature
Pertinent Clinical Hx:

Pre-Operative / Operative Dx (May use ICD-9 Codes):

PLEASE FILL
Specimen / Exact anatomical source: *Label specimen with patient name, MR# or DOB and specimen / site

THIS
A. M.

B. N.

C. O.
D. P.

E. Q.

SECTION OUT
F. R.

G. S.
H. T.

I. U.
J. V.

K. W.

L. X.

Rev. 3/13/08 PS44626

10/23/09 PS96049