Important: Instructions for • This test will take more than one day because you need samples from three separate bowel movements. the Fecal Occult • If possible, remove toilet bowl cleaners from toilet tank and flush twice before collecting the samples. Do not use toilet Blood Test (FOBT) bowl cleaners while doing the test. • Try to collect samples from different parts of the stool during For the Hemoccult SENSA test each collection. and most three sample stool tests • Keep card away from heat, light, and chemicals. www.doh.wa.gov/cfh/BCCHP • Keep cover of card closed when not in use. • Do not collect stool samples while you have bleeding hemorrhoids or blood in your urine. • Women: Do not collect stool samples during your menstrual period (wait until three days after the bleeding has stopped). DOH 342-052 March 2010

Your special instructions regarding dietary or medication restrictions:

Photos used by permission from University of Washington, International Community Health Services, Harborview Medical Center, Fred Hutchinson Cancer Research Center. If you have questions, call: For persons with disabilities, this document is available on request in other formats. To submit a request, please call 1-800-525-0127 (TDD/TTY 1-800-833-8388). Instructions About the test 1 2 3 4 5 This test looks for hidden (occult) blood in your stool (fecal matter). Hidden blood is sometimes a sign of polyps (growths) in your colon that may turn into cancer. Completing this Prepare Card Collect Stool Place Stool on Card Close Cover Repeat, then Mail test is important because • Remove the card from the • Flush toilet and allow the • Open front of section 1. • Close the cover of section • Use sections 2 and 3 even if you have a polyp, paper envelope. Write your bowl to refill. Use one of the sticks in the 1 and insert the front flap for your next two bowel you may never feel name, age and address on • Unfold the flushable tissue kit to take a small sample under the tab. movements. Repeat the the front of the card with a paper that is included in of stool from the tissue • Store the card in the collection steps you used for symptoms—only screening pen. Store the card in the paper. Put a thin smear of section 1. can detect it. If blood the kit and float it on the envelope until your next envelope. surface of the toilet bowl the stool in the “A” area of bowel movement. Keep the • After completing the last is found in your stool • Before collecting your stool water. Let the edges of the section 1. card in a cool dark place, section, let the card dry through this test, you will sample, write the date on paper stick to sides of the • With the same stick, take but not in the refrigerator. overnight in the paper be recommended to have section 1 of the card. bowl. Your stool will fall on a second sample from a • After you are done, wash envelope. a colonoscopy. the tissue. (Note: do not be different part of the stool. your hands. • The next day, remove the concerned if some water Smear this sample on area card from the envelope collects on the tissue). “B” of the same section. and place in the foil-lined Flush the tissue. Wrap the mailing pouch. Seal the stick in toilet paper and put pouch carefully and mail it in the trash. immediately to your doctor or clinic, or you may take the card to your doctor’s office.