PALOMAR POMERADO LABORATORY SERVICES Palomar Medical Center Laboratory (760) 739-3030 Pomerado Hospital Laboratory (858) 613-4113 Client Services (760) 739-2867 or (858) 613-4282

Table of Contents

Laboratory Leadership ...... 3 Outreach Laboratory Services: ...... 4 Courier Service: ...... 5 Prompt Reporting/Turn-Around-Time: ...... 5 Result Reporting ...... 5 Repeat Determinations...... 6 Cancellation Of Tests...... 6 Referred Tests ...... 6 Professional Courtesy: ...... 6 Standing Orders: ...... 6 Quality Assurance...... 6 Reportable Disease...... 7 Clinical Trials...... 7 Supplies:...... 7 Specimen Collection Stations ...... 7 Billing Services...... 8 Test Requisition Information ...... 10 Specimen Collection and Handling ...... 12 Specimen Collection ...... 12 Blood...... 12 Transfusion Services...... 13 Urine ...... 14 24-Hour Urine Collections:...... 15 Stool ...... 16 Rectal Swabs:...... 17 Ova and Parasites:...... 17 Microbiology Culture Samples...... 18 Specimen Handling ...... 23 Labeling ...... 23 Storage ...... 24 Centrifugation ...... 24 Specimen Transport ...... 25 Specimen Rejection ...... 25 Anatomic Pathology And Cytology ...... 28 Pathology Specimen Containers ...... 28 Cytology Specimens ...... 28 Gynecologic Cytology Specimen (Pap Smear) Collection and Requirements...... 29 Unacceptable Specimens ...... 30 Cytology Supplies...... 30 Quality Assurance...... 30 Non-Gyn Cytology Specimen Requirements...... 30 Appendix...... 34 Specimen Requirements: ...... 34 Critical Values ...... 52 Critical Tests ...... 55 Stat Tests:...... 56

Laboratory Leadership

Valley Pathology Medical Associates, Inc. Jerry Kolins, M.D. Medical Director William Tench, M.D. Pamela Danque, M.D. Blesilda Singh, M.D. Linda Petroff, M.D. Lachlan McLeay, M.D. Keith Lopes, PA

Palomar Pomerado Laboratory Services: Mark Reyes, MT (ASCP) MBA District Director, Lab Operations

Tim Barlow, MT (ASCP) MaryAnn Snoke Manager, Laboratory Services – PMC Phlebotomy Supervisor - PMC

Gloria Austria, MT (ASCP) Debra Mason, MT (ASCP) Manager, Laboratory Services – Pomerado POCT Supervisor

Ted Drescher Rose Pfliger Office/Phlebotomy Manager Anatomic Pathology Transcription Supervisor

Robert D’Orazio, MT (ASCP) Brian Bakerink Chemistry Supervisor Supervisor- Cyto/AP Assistants

Joane Barriteau, MT (ASCP) Evelyn Chua, MT (ASCP) Hematology Supervisor Evening Shift Supervisor - PMC

Gary Wilson, MT (ASCP) Rebecca Anderson, MT (ASCP) Blood Bank Supervisor Night Shift Supervisor - PMC

Susan DeWindt, MT (ASCP) Robert Sharpell, MT (ASCP) Microbiology Supervisor Laboratory Info System Analyst – PMC

Sandy Lajeunesse, MLT (ASCP) Jim Peters, MT (ASCP) Central Processing Supervisor Laboratory Info System Analyst – Pomerado

Outreach Laboratory Services: PPLS Client Services Department: Phone: (760) 739-2867 or (858) 613-4282 Fax: (760) 739-2864 Ted Drescher, Office/Phlebotomy Manager (760) 739-3026

Hours of Operation: Monday – Friday 8:00 A.M. – 5:00 P.M.

Our Customer Service Representatives will gladly help you with your requests for test results, telephone orders, courier pick-ups, specimen requirements, turnaround times, and supply orders. After hours, please call the PPLS Client Services Department and follow the steps to be transferred to Palomar Medical Center or Pomerado Hospital.

Professional Consultation Our pathologists are always available to answer your questions, discuss test results and consult on unusual cases. Please call either Palomar Medical Center at (760) 739-3030 or Pomerado Hospital Laboratory at (858) 613-4649. Laboratory managers and technical staff are also available to answer your questions regarding clinical laboratory testing.

Fully Accredited Laboratories Palomar Pomerado Laboratory Services is acknowledged as a high quality laboratory and is accredited by the following: College of American Pathologists (CAP) Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Centers for Medicare and Medicaid Services (CLIA) State of California Department of Health Services (DHS)

Pomerado Hospital Palomar Medical Center CAP # 23184-01 CAP # 23149-01 Federal Tax ID # 95-6003-843 Federal Tax ID #95-6003-843 FI Medicare Provider # 050636 FI Medicare Provider # 050115 California State License # CLF 3150 California State License #CLF1006 CLIA ID # 05D0668540 CLIA ID # 05D0671677 Medi-Cal Provider # ZZT40636F Medi-Cal Provider #ZZT40115F NPI 1376513754 NPI 1457321317

Courier Service: (760) 739-2867 or (858) 613-4282 Hours of Operations: Monday – Friday 8:00 A.M. – 8:00 P.M. Saturday – Sunday 8:00 A.M. – 4:30 P.M. *Holidays by special arrangement Whenever possible, courier pick-ups will be scheduled around your office hours. Lock boxes for after hours service are also available. * STAT courier services are available. In most cases a courier will be to your office within one (1) hour of your call.

Prompt Reporting/Turn-Around-Time: Specimens are processed and test results are reported to the client as soon as possible. Since reporting times vary, a testing schedule is available from the Outreach Laboratory office.

Result Reporting Routine Results are available within 24 hours. ASAP Results are available within four (4) hours after specimen is received in laboratory. STAT Results available within one (1) hour after specimen is received in the laboratory.

Lab Result Calling After Hours The CLS performing the test will call critical results with no time restrictions Calling Protime results: • The lab will order all Protimes as AS/AS unless otherwise requested by physician. • All STAT Protimes received after 4 PM shall be called to Physician or Institution. • ASAP Protimes with normal results shall not be called after 8:00 p.m. but must be called the next business day.

NOTE: The front office personnel will check the requisition for complete physician information including after hours contact number. In the event that the information is not available the laboratory personnel will: • Call the patient to get the physician information. ?? • If information is still not available, CLS will call the pathologist on call.

Result Faxing: All laboratory results will be automatically faxed to your office. This includes clinical, cytology and anatomic pathology reports.

Critical Value Handling The laboratory will immediately call results that fall within a range, which has been determined to be Critical or may have an effect in delaying surgery or need to be brought to the attention of the physician. You will find a list of the PPLS Critical Values in the Appendix.

“STAT” Test List: A complete list of Outpatient “STAT” tests can be found in the Appendix of this manual.

Repeat Determinations We will repeat a test without charge whenever the result does not correlate, in the physician’s opinion or with the clinical picture presented by the patient. Contact the Outreach Laboratory office with any requests for repeats. Follow-up or confirmatory testing is not considered a repeat determination, and such specimens will therefore be processed as a new request.

Cancellation Of Tests Cancellations received prior to test setup will be honored at no charge. Requests received following test setup or resulting cannot be honored.

Referred Tests PPLS is a full service laboratory. Most tests are performed in our laboratories; however, a few highly esoteric tests are referred to reliable reference laboratories. We use the services of ARUP Clinical Laboratories as our primary reference laboratory. The fees for referred tests are subject to change and a fee is added to cover handling expenses.

Professional Courtesy: California State and Federal Laws prohibits the offering of “professional courtesy testing”; therefore we cannot honor requests for this service.

Standing Orders: Standing orders are permitted at PPLS as long as they are valid, documented, medically necessary, and monitored for appropriateness. Standing orders must be in written form and must include a duration, frequency of testing, diagnosis, and physician’s signature and be no more than 6 months old. PPLS reviews standing orders on a regular basis and may send written notification requesting renewal of the order.

Quality Assurance PPLS utilizes state-of-the-art, technologically advanced diagnostic techniques. Participation in the College of American Pathologists (CAP) and other proficiency testing programs fore every reported analyte assures our outstanding performance for accuracy and performance. We maintain continuous internal quality improvement audits throughout all departments and participate in health system wide Professional Practice Improvement Teams.

Reportable Disease All reportable diseases are reported to the County of San Diego, Public Health Department as outlined by Title 17 California Code of Regulations (17CCR). Within 24 hours of identifying a reportable organism, a Confidentiality Morbidity Report (CMR) is completed and faxed to San Diego County Public Health.

Clinical Trials We are here to assist offices that are participating in a Clinical Trial Study. Contact the Outreach Laboratory office for further assistance, (760) 739-2867.

Supplies: PPLS will provide, at no charge, supplies necessary for the collection and transportation of specimens for analysis at our laboratories. We cannot provide supplies used for in office testing. To order supplies, simply fill out a Supply Request form and give to your lab courier or simply call the Client Services Line: (760) 739-2867 or (858) 613-4282. A list of supplies is located in the Appendix.

Specimen Collection Stations PPLS provides Specimen Collection Stations in the Escondido and Poway areas. Appointments are not necessary, however, they are appreciated for Glucose Tolerance testing. Locations: Escondido: Palomar Medical Center 555 E. Valley Parkway, 3rd Floor Phone: (760) 739-3030 Monday – Friday: 7:00 A.M. – 7:00 P.M. Saturday; 8:A.M. – 4:00 P.M. Sunday: 8:00 A.M. – 3:00 P.M. Six parking spaces are allocated for Laboratory patients. Please use the hospital entrance at Grand Avenue. Parking spaces are near the entrance for Rehabilitation/ Outpatient Services

Poway/Rancho Bernardo: Pomerado Outpatient Pavilion: 15611 Pomerado Road, 1ST Floor Phone: (858) 613-4282 Monday – Friday: 7:00 A.M. – 6:30 P.M. Saturday: 8:00 A.M. – 1:00 P.M. Sunday Closed Park in the parking garage behind the Outpatient Pavilion, at the north (far) end of the garage on the first floor. Use the walkway or wheelchair ramp to the Lab Speciment Collection Site on the first floor. For STAT testing after hours or Sundays, Pomerado Hospital Laboratory is available.

Billing Services Palomar Pomerado Health will bill all insurances on behalf of our customers for clinical laboratory services.

Valley Pathology Medical Associates, Inc. will bill for professional clinical and pathology services (histopathology and cytology).

It is the responsibility of the customer to check with his/her insurance company prior to using our service to assure that Palomar Pomerado Laboratory Services is a network provider.

The billing office is open Monday through Friday. For questions regarding billing feel free to contact them. Palomar Pomerado Health Billing: (858) 675-5360 Valley Pathology Medical Group, Inc. Billing (McKesson Corp.): 903-450-4450

Billing Information: Palomar Pomerado Health Billing Department routinely bills most major medical insurance carriers, as well as smaller local carriers. In addition, we participate in many PPO/IPA/HMO managed care healthcare delivery systems.

Please check the appropriate boxes and submit all necessary billing information on the test requisition form.

Private Patient Medicare - Patient’s Complete Name - Patient’s Complete Name - Sex - Sex - Date of Birth - Date of Birth - Current address, including apt # - Current address, including apt. # - Telephone number - Telephone number - Name of responsible party, if other than - Medicare number patient - Copy of insurance card, both sides - Diagnosis (ICD-9 Codes) - ** Diagnosis (ICD-9 Code)

Bill Insurance Medi-Cal - Patient’s complete name - Patient’s complete name - Sex - Sex - Date of Birth - Date of Birth - Current address, including apt. # - Current address, including apt. # - Telephone number - Telephone number - Name and address of insurance company - Proof of eligibility (copy of current month eligibility or POE sticker) - Copy of both sides of insurance card - Diagnosis (ICD-9 Codes) - Diagnosis (ICD-9 Codes)

* Workman’s Compensation claims: Submit social security number, insurance identification number and the exact date of injury.

* TriCare: Submit the patient’s identification number, sponsor’s status (active duty, retired, dependent) and expiration date and a copy of insurance card.

Bill Physician/Facility - Provide all patient demographics - Clearly mark the Bill To:” Physician Account” box

When at all possible, it would be very much appreciated if the patient’s Social Security Number (SSN) would be provided on the test requisition.

** NOTE: Advanced Beneficiary Notice (ABN): When ordering tests for which Medicare reimbursement will be sought, provide all applicable diagnosis codes to the tests that are being ordered. Tests ordered that are determined not “medically necessary”, will not be reimbursed by Medicare. “Medical Necessity” is determined by the use of a diagnosis (ICD-9) code appropriate for the test ordered.

Test Requisition Information PPLS provides three types of personalized requisition forms for your convenience. They include: • Clinical Laboratory testing - Blue/White form • Cytology testing – Purple • Tissue/Surgical testing - Green A request form or physician’s order must accompany each laboratory order or specimen you submit.

Filling Out the Palomar Pomerado Laboratory Requisitions: • Clinical Laboratory: Blue/White o Patient’s full name (last, first, middle initial) o Current address o Phone number o Date of Birth o SSN, if possible o Check appropriate billing category and attach a copy of insurance card o Provide ICD-9 code(s) or chief complaint. This is a federal requirement and failure to provide may result in insurance denial. o Clearly mark tests to be performed. If not listed, use the “Write-In” area. o Clearly label each specimen being submitted with patient’s name, date and time of collection. Use the identification labels provided. o Microbiology testing – please indicate the “source” of the specimen being submitted for culture. The back of the requisition contains a complete list of panel components, specimen collection tube codes and reflexive tests.

• Cytology: Purple o Patient’s full name (last, first, middle initial) o Current address o Phone number o Date of Birth o SSN, if possible o Date and time of collection o Check appropriate billing category and attach a copy of insurance card o Provide ICD-9 code(s) o For Pap smears indicate if you want HPV testing o Source of material submitted (cervical, endocervical, vaginal or other gyn or non-gyn site) must be provided o Patient history or clinical information is required. o Pap Smears: LMP, Date and Diagnosis of last Pap Non- Gynecological Cytology: urine, sputum, pleural fluid, etc. A brief clinical history MUST be provided at the time of specimen submission. ICD-9 codes, alone, are not acceptable.

• Tissue: Green o Patient’s full name (last, first, middle initial) o Current address o Phone number o Date of Birth o SSN, if possible o Date and time of collection o Check appropriate billing category and attach a copy of insurance card o Clinical information, please complete all areas that are related to the tissue specimen being submitted. Provide the operative procedure and presumptive diagnosis. Gynecological specimens require that any hormone therapy information be included. o Clinical History must be provided with all specimens. If not provided, the requisition will be returned to your office for this information thus delaying a final report. This information is invaluable to the pathologists as they make their diagnosis. o List all specimens being submitted. Identify the specific anatomic location for each biopsy.

Specimen Collection and Handling Laboratory test results are dependent on proper collection and handling of the specimen. It is also important that all specimens and requisition slip be properly labeled. Specific instructions for the proper collection and handling of specimens must be made available to laboratory personnel and to anyone collecting patient test materials that are sent to the laboratory.

This manual is reviewed at least annually by the current Medical Director or by the owner of this procedure as the Medical Director's designee. However, the Medical Director must approve all revisions to this procedure manual.

This specimen collection manual is available to all specimen collecting areas within the hospital (nursing stations, operating room, emergency room, outpatient areas) as an electronic copy via LUCIDOC and to areas outside the main laboratory (such as physicians' offices or other laboratories) as hard copies.

Specimen Collection Blood Patient Preparation • Before proceeding with the blood collection, review first if the patient needs special preparation or any special instructions such as fasting sample. o An overnight fast is required for most fasting specimens. Some tests, particularly lipids, triglycerides and lipoproteins, require further dietary restriction. For these tests, nothing should be eaten 14 hours prior to specimen collection. The evening before the specimen is drawn, the meal should contain no fatty foods or alcohol and must be complete before 6 pm. • Always identify yourself to the patient upon entering room; be congenial, professional and polite. Be careful not to startle patient; this may alter test results. • Patient Identity: Absolute patient identity must be established prior to phlebotomy. At least two forms of patient identification should be used before obtaining blood samples. • Inpatients: o All inpatients must have a hospital armband affixed to their person (usually the wrist or ankle). The first identifier is to ask the patient his or her name. If patient is incoherent ask the nurse taking care of the patient to identify the patient. o The second identifier is to check patient name and medical record number on the armband against the name & medical record number printed on the test order labels. • Outpatients: o The first identifier is to ask patient to state his/her name. o Secondly, patient identity can be verified by any pictured ID. This may include, but not limited to the following: valid driver's license, workplace badge, a pictured credit card, state ID card or military card o Minors may be verified by having the parent or guardian identify them as a second identifier in lieu of a pictured ID.

• Inspect Requisitions/Review Demographics, Testing And Tube-Type: o Re-examine requisitions/labels and insure the appropriateness of tubes for specimen collections of ordered testing. o Label/Requisition should include: o Patient's full name. o Medical records# (hospital ID#) o Patient location o Sex o Age o Ordering physician's name o Collection/reporting priorities; RT, ASAP, STAT, timed study (TS), etc. Time and date of desired collection should also be included on requisition/label. o Testing required: o Color tube required for desired testing; detailed list including color coding vs. additive, and sample size included in Phlebotomy Section collection manual. The alpha listing includes test name(s), sample size, tube color, additive, and special specimen handling. ( See Specimen Requirements Procedure) o Recommended sample size; pediatric or minimum sample size requirements included in detail in lab procedure entitled "Neonatal Specimen Requirements," o Specimen handling; e.g. refrigerate, freeze, etc. o Additional information. o Date of birth o Accession number o Downtime Requisition: o During periods of computer down- time, manual requisitions will be used. All floors requesting lab collection for testing will notify lab immediately by phone or beeper of STAT, ASAP or impending timed study. Downtime requisition should have patient information. These requisitions, manual downtime, or Trauma, may not contain all the information needed. o However, they should include: patient's full name or trauma assigned name (e.g. "Trauma B55"), medical records # if known, Blood Bank band number as indicated, sex, date, physician's name, testing required (consult alpha listing for lab testing/color coding and sample size), and patient location.

Specimen Collection Procedure - See Phlebotomy Procedure

Transfusion Services- Note: All patients for possible blood product transfusion can only be drawn by the laboratory. • Patient Identification - The identification data shown on the specimen must agree with the information on the requisition or in the computer. The minimum information required is: o Patient's first and last name. o Hospital medical record number, if any. o BB number (if any blood components are to be administered). o Time and date of draw. o Initials of person or employee id number of the person collecting the specimen, not "NL" (Non Laboratory collected). o Number of units, date of use, product, ordering physician, and order priority are provided by written or electronic order. o All specimen for transfusion must be hand labeled (except for the BB number). No computer-generated labels are allowed o The Cerner label will be placed on the specimen by a Clinical Laboratory Scientist who will leave the original patient name visible and initial the Cerner label with their email id. • Specimen Volume: o A 7 ml lavender top is the preferred specimen for routine tests: ABO and Rh type, type and crossmatch, type and screen. o A plain red top can also be accepted. o Minimum volume is 2 ml for an adult, one capillary EDTA for a newborn. o Minimum sample for Red Cross antibody id is 10 ml red top plus 10 ml lavender top. Urine For culture and routine urinalysis, please follow the clean catch midstream instructions listed below • Clean-Catch Midstream Urine Collections (females): o Wash hands thoroughly with soap and water. Dry completely o Spread labia apart with one hand and thoroughly cleanse vulva with towelette. Keep labia continuously apart until urine is collected. o Allow the first stream of urine to drain into the toilet and place a urine container under the stream and fill the container. Do not touch the rim or inner surface of the container. o Place and tighten lid on the container. o Label container with patient’s full name, medical record or requisition number date and time of collection. o Place specimen in a biohazard bag together with the requisition or nurse collected downtime form. o Keep specimen refrigerated until it can be transported to laboratory. • Clean-Catch Midstream Urine Collections (males) o Wash hand thoroughly with soap and water. Dry completely. o Completely retract foreskin (if uncircumcised) and thoroughly cleanse glans penis with towelette. o Allow the first stream of urine to drain into the toilet and place a urine container under the stream and fill the container. Do not touch the rim or inner surface of the container. o Place and tighten lid on the container. o Label container with patient’s full name, medical record or requisition number date and time of collection. o Place specimen in a biohazard bag together with the requisition or nurse collected downtime form. o Keep specimen refrigerated until it can be transported to laboratory.

Note: Urine specimens for AFB and Fungus should be first morning specimens; 3 consecutive clean, voided early morning specimens recommended for AFB. 24-hour collections are unacceptable. 24-Hour Urine Collections: PPLS provides 24-hour urine collection containers with various types of preservatives depending on the test requested. Use the following procedure for the correct specimen collection and preparation.

Note: Unless indicated by the physician, patient should maintain normal daily fluid intake, avoiding alcohol and non-prescription medications. • Warn the patient of the presence of potentially hazardous preservatives in the collection container. To avoid burns, patients must not urinate directly into these containers. Urine should be collected in a separate bottle, then carefully poured into the bottle containing the acid. • Instruct the patient to discard the first morning specimen and to record the time of voiding on the specimen collection container. • The patient should collect all subsequent voided urine for the remainder of the day and night. • Collect the first morning specimen on day two (2) at the same time as noted on the day one.

o ** Note: All urine voided during the 24-hour period must be collected and saved. If one container is not sufficient, you need to pick up another one from the laboratory. Using a container other than that provided by the laboratory may compromise the specimen and require recollection. • 5. Send entire container to laboratory properly labeled with patient name, dates and time of collection. • 6. Label specimen with patient’s full name, medical record or requisition number, date and time of collection. • Complete a nurse downtime form or blue and white requisition form with patient information, collection date and time and indicated clinical data. • Creatinine Clearance: o The patient should be hydrated by administering a minimum of 600ml of water before the collection period. During the collection period, the patient should continue to drink plenty of water and avoid coffee, tea, and drugs. o In addition to the 24-hour urine sample, creatinine clearance calculation requires the patient's height and weight and serum for creatinine, preferably collected during the time of the urine collection

• Specimen should be submitted to PPLS within eight (8) hours following the end of the collection.

Stool A. Occult Blood (Hemoccult): Patient instructions and preparation- • Specimens may be collected all on the same day or on different days, as long as, they are three (3) different bowel movements. • Obtain a small stool specimen from the toilet bowl using the collection tissues and applicator sticks provided in the Hemoccult II Sensa kit. • After collecting each specimen, apply a thin smear onto the windows inside the test slide. • Protect slides from heat, light and chemicals. • Keep cover flap of slides closed when not in use. • 7 days prior to and during the test period omit aspirin or non-steroidal anti- inflammatory drugs. (Acetaminophen is allowed) • 3 days prior to and during the test period omit:Vitamin C in excess of 250 mg/day, Red meat and Raw vegetables • Label EACH card with patient name and date and time of collection. B. Stool Culture: Outpatient instructions and preparation • Three- (3) specimens collected over separate days are recommended. Stool specimens are not recommended on patients who have been hospitalized for >3 days and were not admitted with a diagnosis of gastroenteritis. Please indicate on the requisition if bacteria other than Salmonella, Shigella, or Campylobacter are suspected. • If the specimen cannot be delivered directly to the laboratory within one (1) hour after collection, contact the laboratory to obtain the enteric transport media. (Cary-Blair, C&S medium) • Avoid mixing stool specimen with any urine or water from toilet. • To collect specimen, you may use a wide mouth sterile container (similar to a margarine container), or raise the seat of the toilet, cover the bowl with clear plastic wrap and put the seat down. • When you have obtained the specimen, take the enteric transport media container with the red fluid and put enough stool sample into the vial to raise the fluid level above the small arrow on the label. Shake vigorously until the contents are well mixed. • This specimen may be collected at the same time as any other stool specimen. • Label the container with patient’s name, medical record or requisition number, date and time of collection. • If collected in a preservative, store specimen at room temperature. If the stool is not collected in a preservative, return to the laboratory as soon as possible or refrigerate the specimen up to 24 hours. Rectal Swabs: • These should only be used for infants or acutely ill patients when a stool is not available for culture. Rectal swabs are also submitted for the detection of Neissseria gonorrhea or anal carriage of Streptococcus pyogenes. (Please indicate “r/o N. gonorrhea or r/o S. pyogenes on the requisition.) • Pass the tip of the swab approximately 1” beyond the anal sphincter. • Carefully rotate swab. • Replace swab in culturette container and crush ampule. • Transport at room temperature.

Ova and Parasites: Outpatient instructions and preparation • If the specimen cannot be delivered directly to the laboratory within 1 hour of collection, obtain collection kits with preservative and instructions from the laboratory. • The collection kit will contain two (2) vials. Both vials must be collected from the same bowel movement or stool. • Avoid mixing stool specimen with any urine or water from toilet. • Collect as instructed, filling each vial so the fluid level is higher than the line or arrow on the side of vial. Select areas of the stool that are bloody or contain mucous. • Shake vigorously until the contents are well mixed. • If collecting more than one specimen, collections must be from separate days. Three (3) specimens collected every other day are recommended. • Store all vials at Room Temperature. • Label each container with patient’s name, date and time of collection. • Send to laboratory as soon as possible. • Note: Specimens for O&P collected too soon after administration of mineral oil, magnesium, barium, or bismuth are unacceptable. Specimen collection should be delayed 5-10 days after any of these agents have been given. Clostridium difficile (C.difficile) • This requires a minimum of 1 ml or 1 gm of raw liquid stool • Collect in a sterile wide-mouth container. • Refrigerate and return to the laboratory within 4 hours of collection. • If specimen cannot be delivered to laboratory within 24 hours, Freeze. • Label container with patient’s name, medical record or requisition number, date and time of collection. • Carey Blair preservative is not acceptable. Pinworm Paddles: • For the collection and examination of the pinworm Enterobius vermicularis. Because of the migratory habits of the female pinworm, specimens are best obtained a few hours after the patient has retired for the night, between the hours of 9:00 p.m. and midnight; or in the morning immediately upon rising before bathing or bowel movement. • Hold the paddle by the cap and remove from the tube. • Separate the buttocks and press the sticky side of the paddle against several areas of the perianal region. • Replace the paddle in the tube for transport to the laboratory. Specimen should be delivered as soon as possible. • Label tube with patient’s full name, medical record or requisition number and date and time of collection. Microbiology Culture Samples A. Aerobic Culture: 1. The laboratory will provide you with routine transport or Mini-Tip transport swabs for the collection of routine/ aerobic cultures, gram stains and wet mounts. The breakable ampule contains Stuart’s holding media. For viral cultures, use viral transport media. 2. Typical SOURCES: Throat, Ear, Aerobic Wound., Cervical or genital specimens. 3. Peel apart package. 4. Remove swab holding the plastic cap. 5. Collect specimen on swab. 6. Replace swab and gently break the ampule to moisten swab. 7. Maintain at room temperature. 8. Label with patient’s full name, medical record or requisition number, date and time of collection and INDICATE SOURCE on the label. 9. Label must be placed on the culturette swab and not on the paper wrapper. 10. The date, time of collection, and source must be included as well on the laboratory requisition. 11. Forward promptly to the laboratory at ambient temperature B. Mini-Tip Culturette: 1. Typical Sources include: Nasopharyngeal, Eye and male urethral specimens. 2. Peel apart package. 3. Remove swab holding the plastic cap. 4. Collect specimen on swab. 5. Replace swab and gently break the ampule to moisten swab. 6. Maintain at room temperature. 7. Label with patient’s full name, medical record or requisition number, date and time of collection and INDICATE SOURCE on the label. 8. Label must be placed on the culturette swab and not on the paper wrapper. 9. The date, time of collection, and source must be included as well on the laboratory requisition. 10. Forward promptly to the laboratory at ambient temperature C. Throat Specimens: 1. Using a tongue blade to hold the tongue down, rub the swab over the posterior pharynx, tonsillar area, behind the uvula and any inflamed or ulcerated areas. 2. Withdraw the swab, being careful not to touch the cheeks, teeth or gums. 3. Insert swab back into culturette and crush the ampule 4. *Note: Swabs with gel preservative are not acceptable for Rapid Group A testing. 5. Submitted primarily for the detection of carriers of N.meningitidis or to diagnose D. Nasopharyngeal Specimens: 1. B.pertussis or RSV a. For RSV, nasal washes or aspirates are preferred but two (2) mini-tip culturette swabs are acceptable. b. Gently pass the swab through the nose and into the nasopharynx. c. Rotate the swab on the nasopharyngeal membrane and allow the swab to remain in place for 10-15 seconds to absorb the organisms. d. Remove the swab carefully and place in transport media. 2. Nasal Swabs: a. Submitted primarily for detection of Staphylococcal carriers b. Insert swab at least 1 cm. into nares c. Rotate the swab against the nasal mucosa. d. Repeat process on the other side. E. Anaerobic Culture 1. When ordering a culture for ANAEROBIC ORGANISMS, always include both the aerobic culturette and anaerobic culturette. If only an aerobic culturette is submitted, the specimen will not be processed for anaerobic culture testing. 2. Syringe aspirates or tissue specimens are also acceptable. If submitting a syringe, remove the needle and place the syringe cap on the end. DO NOT submit a specimen with the needle attached. 3. To use Anaerobic collection system: a. Peel apart package; pull out swab using white plunger; do not take off grey stopper at anytime. b. Collect specimen on swab or if you have liquid specimen, transfer the liquid to the small inner tube aseptically. c. Replace swab and push down gently on the white plastic plunger, forcing the inner glass tube into large glass tube. Plunger should be flush with rubber stopper surface. 4. Transport tube upright if a liquid specimen was collected. 5. Store at room temperature. 6. Label culture tube with Patient’s name, medical record and requisition number, date and time of collection, and Source.Do not place label on the paper wrapper. 7. The date, time of collection, and source must be included as well on the laboratory requisition. 8. Forward promptly to the laboratory at ambient temperature. 9. Note: A complete list of suitable sources for anaerobic culturing and transport media are listed in the Anaerobe Culture Workup procedure F. Genital Specimens: 1. GEN-PROBE Testing for CHLAMYDIA and GC: DNA hybridization method for the detection of Chlamydia trachomatis and Neisseria Gonorrhea. Female and Male kits available through the laboratory a. Endocervical Sampling: i. Remove excess mucus from cervical os and surrounding mucosa using one of the swabs provided. Discard this swab ii. Insert second swab from collection kit 1 to 1.5 cm. into endocervical canal. iii. Rotate swab clockwise for 10-30 seconds in endocervical canal to ensure adequate sampling. iv. Withdraw swab carefully; avoid any contact with vaginal mucosa. v. Label tube with patient’s name, medical record or requisition number, date and time of collection. b. Urethral Sampling: i. Patient should not have urinated for at least one (1) hour prior to sampling ii. Insert swab 2-4 cm. into urethra. Rotate clockwise for 2-3 seconds to ensure contact with all urethral surfaces. iii. Withdraw swab. iv. Label tube with patient’s name, medical record or requisition number, date and time of collection. 2. Wet Mounts a. Vaginal wet mounts will be examined for the presence of yeast, clue cells, Trichomonas, and WBCs. b. Collect vaginal secretions on a routine transport swabs. c. Label with patient’s name, medical record or requisition number, and date of collection d. Transport at room temperature within 24 hours. e. If Trichmonas is suspected, best results are obtained if the specimen is submitted within 4 hours of collection. 3. Genital Culture a. Note: Do Not use lubricant during procedure, it can be toxic to Niesseria. b. Wipe the cervix clean or vaginal secretions. c. With a sterile swab, obtain discharge from the endocervical glands. d. If no exudate is seen, insert the swab into the endocervical canal and rotate. e. Place swab in culturette. f. Label with patient’s name, medical record or requisition number, date and time of collection g. Do not refrigerate, transport promptly to laboratory. 4. Group B Strep a. For the detection of Group B Streptococci in women, a swab of the vaginal introctus and anarectum should be obtained. b. Cervical cultures are not acceptable and a speculum should not be used. G. Sputum Collection: 1. Contact the laboratory for this kit. 2. For the collection of sputum specimens for routine culture, AFB culture*, fungus culture, or cytology. 3. The first morning Deep Cough specimen is the most desirable; however, Deep Cough specimens obtained at any other time are equally acceptable. 4. Remove collector from plastic bag. 5. Lift hinged top. 6. Produce sputum with a deep cough and expectorate it into container. 7. Close lid tightly. 8. Label specimen container with patient’s name, medical record or requisition number, date and time of collection. 9. Refrigerate specimen if unable to transport to lab within 2 hours of collection. 10. Note: AFB Cultures must be the first morning Deep Cough specimen. For AFB or Fungus culture, collect three (3) early morning specimens from a deep cough. These must be collected on separate days. H. Fungus Specimen Collections for Culture and KOH: 1. Hair a. Examine the head for scaly patches. Broken hairs, pus or crusting may be visible. b. With tweezers or forceps, grasp the hair above the infected area where the hair shaft looks healthy. Remove at least 10 hairs and place in a sterile container, such as a urine collection cup. c. If the hairs are broken, and significant crusting is seen, use a sterile scalpel blade to scrape these hairs and material into a sterile container. d. Label the container with patient’s name, medical record or requisition number, date and time of collection. 2. Nail a. Clean the nail surface with 70% alcohol. b. With a sterile scalpel, scrape off the exterior surface of the nail. Discard these scrapings. c. With a new scalpel, scrape off a deeper portion of the nail into a sterile container. d. Nail clippings or a removed nail may be submitted in a sterile container. e. Label the container with the patient’s name, medical record or requisition number, date and time of collection. 3. Skin a. Skin specimens may be the webbing between toes, a ringworm lesion, or vesicles in the skin surface. b. Wipe the affected area with 70% alcohol and allow to dry completely. c. With the flat side of a sterile scalpel, scrape the skin. Place the scrapings in a sterile container. d. For loose skin, crusty lesions or large vesicles, the sharp side of a scalpel may be used to scrape away the specimen. Avoid causing nicking or bleeding, if possible. e. Label the container with the patient’s name and date of collection.

NOTE: KOH only · If a KOH is requested with no culture, the skin or nail scrapings and hair shafts may be placed between two (2) glass microscope slides. · Tape the slides together and place in a container labeled with the patient’s name and date of collection. · Cultures will not be done from these specimens because the transport system is not sterile. Contamination of any fungal specimen may compromise results due to the overgrowing of the infectious fungus. I. Blood Cultures: 1. Contact laboratory for collection bottles. No more than three (3) draws in a 24- hour period of time. a. Routine collection = 1 set of bottles: i. Blue top BacT/ALERT bottle (aerobic) 5-10ml blood ii. Purple top BacT/ALERT bottle (anaerobic) 5-10ml blood pediatric collection = 1 bottle; Yellow BacT/ALERT bottle .5 to 2 ml blood. b. Difficult collection = For adults: < than 5 ml total specimen collected, add entire contents to BacT/ALERT pediatric(yellow) bottle. If greater than 5 and < than 10 ml collected, add entire contents to BacT/ALERT aerobic (blue) bottle. c. When multiple cultures are ordered (e.g. Blood c/s times 2) each set will consist of 1 aerobic (blue) bottle and 1 anaerobic (purple) bottle, unless the patient qualifies as a difficult draw (see above). For this example, after the second set of cultures are collected, you will have a total of "4" bottles to submit to Microbiology for testing. 2. Blood Culture Collection on I.V site a. Collection of blood cultures from an I.V. site should only be performed when specifically ordered by the physician. b. Have nursing personnel stop the I.V. for 3 minutes prior to drawing the specimen. Avoid drawing from lines within an hour of completion of antibiotic administration through I.V. c. Clean the catheter hub for 15 seconds with 70% alcohol prep. d. Repeat step b. e. Allow hub to air dry. f. With a syringe, discard the first 3ml of blood, for pediatric patients, discard the first 0.2ml of blood. g. Using a new syringe, collect the blood for the culture. h. Inoculate the bottles and label as outlined in steps 7- 11 below. i. Mark each bottle using large lettering as "Line Draw". 3. Blood Culture Specimen Collection - refer to procedure 5722

Specimen Handling Labeling • To avoid any adverse errors made due to an improperly labeled specimen, it is imperative that proper labeling criteria are met at all times. • Requirements for all specimen coming to the laboratory for testing insist that each specimen have a label on the container in which it is held. It is not acceptable to label the container lid, zip-lock back or any other container used to transport the specimen. • All specimens should be labeled legibly with the following information: o Patient's name (last name, first name). If the patient is not yet registered, a downtime ID band must be used. o Patient's medical record number or other appropriate identification (e.g. blood bank armband number or trauma number) if medical record number is unavailable. o Blood bank armband number must be on the label if any immuno- hematology (e.g. crossmatch, type & screen) are ordered. o Date and time of collection. o Initials of person collecting the specimen. Employees of PPH are to use their employee id number. o The source of the specimen (e.g. throat swab, spinal fluid, bladder, etc.) if other than blood or urine. Storage • Most laboratory tests are performed on anticoagulated plasma, serum or whole blood. Unless otherwise noted, specimens should be refrigerated before and during transport to the laboratory. • The following is the list of tubes referred in the Specimen Requirements procedure: o Green top tube. This tube contains lithium heparin used for the collection of heparinized plasma for chemistry tests or whole blood for special tests. After tube has been filled with blood, immediately invert the tube several times in order to prevent coagulation. o Grey top tube. This tube contains potassium oxalate as an anticoagulant and sodium fluoride as a preservative, used to preserve glucose in while blood and for some special chemistry tests. After tube has been filled with blood, immediately invert the tube several times in order to prevent coagulation o Lavender top tube. This tube contains EDTA as an anticoagulant used for most hematological procedures, BNP and hemoglobin A1c After tube has been filled with blood, immediately invert the tube several times in order to prevent coagulation o Light Blue top tube. This tube contains sodium citrate as an anticoagulant used for the collection blood of blood for coagulation studies. After tube has been filled with blood, immediately invert the tube 6-10 times in order to activate the anticoagulant. Note: It is imperative that the tube be completely filled. The ratio of blood to anticoagulant is critical for valid coagulation study results. If using a butterfly, it is important to waste a tube of blood before drawing the light blue top tube to avoid short draw. o Red top tube (plain). This tube is a plain vacutainer containing no anticoagulant used for collection of serum for selected chemistry tests, especially drug levels. o Serum Separator Tube (SST). This tube contains a clot activator and serum gel separator used for various laboratory tests. Note: Invert the tube to activate the clotting and let stand for 20 - 30 minutes before centrifugation. o Special Collection Tubes. Some tests require specific tubes for proper analysis. Please contact the laboratory prior to patient draw to obtain the correct tubes. • Some samples maybe required to be FROZEN. Specimens that require freezing should be centrifuged, separated, serum and or plasma, transferred in a plastic tube with the patients full name, date and time of collection. Store tubes in an upright position with an airspace at the top. • Some samples maybe required to be tested as WHOLE BLOOD. Collect a sufficient amount of blood with the indicated anticoagulant, gently mix tube 6- 10 times immediately after collection. Take note of the proper specimen storage requirement depending on the test/s ordered. If whole blood sample needs to be refrigerated, store specimen in the refrigerator until transported to the laboratory. NOTE: Tubes intended for whole blood analysis are not to be centrifuged or separated. DO NOT freeze whole blood unless specifically instructed to do so. Centrifugation • Blood samples should be adequately clotted prior to centrifugation. • Centrifugation should be performed at 3000 rpm for 10 minutes. • Tubes of blood, serum, plasma are to be kept closed at all times. This prevents possible exogenous contamination, evaporation, concentration changes or possible spillage and aerosols. Specimen Transport • All laboratory specimens must be placed in a PPLS biohazard bag for transport to the laboratory. • All specimens and request slip or nurse downtime form must be properly labeled with the name of the patient, collection date and time, the origin or source of the sample other than blood. • Specimen could be sent to the laboratory via the pneumatic tube system (CTS) or by hand delivery. • All specimen sent to the laboratory must be properly packaged. o Note: Most problems with tube systems occur when the items are improperly packaged or carriers are not closed tightly. This can cause a jam or contamination of the system. • Under no circumstances will contaminated needles or other sharp, contaminated objects be transported in the PTS system. • Containment prevents leakage. Immobilization of the contents of the carrier is required to prevent breakage. Carriers are provided with padded liners to immobilize the contents in conjunction with biohazard bags. o Liquids must be in a leak-proof container and sealed in a secondary, zip-lock bag to prevent leakage should the primary container fail. o Leakage is due to improper packaging and non-immobilization of contents and failure to tighten container lids or use of non-leak proof containers. • Irreplaceable samples or specimens that are hard to obtain, such as amniotic fluid and CSF, must be hand carried to the laboratory instead of using the pneumatic tube system. Specimen Rejection • The accuracy and precision of laboratory results depends on the quality and integrity of the specimen collected. • PPLS will not perform test on samples if the specimen received is: o Unlabeled - If the specimen is considered irreplaceable, such as CSF, the laboratory will call the healthcare provider to notify that the specimen would be run but with documentation that PPLS could not be certain if the result will be accurate. o Mislabeled - If the specimen is considered irreplaceable, such as CSF, the laboratory will call the healthcare provider to notify that the specimen would be run but with documentation that PPLS could not be certain if the result will be accurate. o Improperly labeled, mislabeled or unlabeled specimen for Blood Bank and HIV testing. o Hemolyzed - Grossly hemolyzed sample will be rejected because it could affect accuracy of some analytes. o Short draw sample will significantly affect coagulation tests because there is an insufficient amount of blood for the amount of anticoagulant present, which can lead to the prolongation of the test results. o Clotted samples for anticoagulated sample will significantly affect platelet count and to some extent coagulation results. o Improperly handled. All specimens must be stored as directed if not sent to the laboratory as soon as possible. • Always review requisition or patient preparation requirement such as before obtaining specimen.

Clinical Laboratory Specimens We primarily use vacuum specimen collection tubes that are color-coded signifying the anticoagulant contained therein or the absence of preservative. The following is a brief description of tube color coding and additive: • Red top tube: no additive. o Required for testing for which serum is indicated as the specimen of choice. • SST - Serum Separation Tube. o Tube of choice for most in- house Chemistry tests, which are analyzed on direct-tube sampling instruments. Contains an inert barrier material. • Lavender top tube: K2EDTA 5.4 mg. o Whole blood used for hematology procedures where cell counting and pristine cell morphology necessary; also used for tests requiring EDTA plasma. EDTA removes calcium from whole blood via chelation (calcium essential for clot formation, consequently clot formation impeded). • Green top tube: lithium heparin 143 IU (crystal). o Used for testing where heparinized plasma is indicated as the specimen of choice. Heparin neutralizes the effect of thrombin and thromboplastin. Also used when methodology requires heparinized whole blood. Sodium heparin also available but should not be used for sodium testing (electrolytes). Green top tubes containing lithium heparin similarly should not be used for lithium level testing. • Grey top tube: sodium fluoride/potassium oxalate (crystal). o Used for chemistry testing where glycoinhibited specimen required, e.g. glucose testing. • Blue top tube: buffered sodium citrate. o 2.7 ml tube contains .3 ml of 3.2% (0.105 M) buffered sodium citrate o 4.5 ml tube contains .5 ml of 3.2% (0.105 M) buffered sodium citrate o Sodium citrate used when coagulation studies ordered requiring plasma specimens; e.g. Protime (PT), Partial Thromboplastin Time (PTT), fibrinogen testing, clotting factor testing (e.g. factor VIII, etc.) • Microtainers. o Used when absolute minimum sample size required or when collecting skin puncture specimens: • Red microtainer-no additive • Green microtainer-lithium heparin, 12.5 IU • Lavender microtainer-K3EDTA (crystal) • Arterial blood gas syringe/plastic: contains lyophilized lithium heparin. o Used for whole blood testing of arterial blood for pH, partial pressure of oxygen, carbon dioxide, and ionized calcium. • Aliquot tubes/transfer pipets/sample cups. o Product insert must be reviewed for possible interfering substances. Review of clinical literature may also be used. Copy of insert and/or literature may be kept on file as evidence of review.

Ascertain and observe all testing requirements essential for the proper collection of lab specimens for specific testing. Depending on testing and testing methodology, tube color and size may vary. Several tests require special handling before and after collection; these must be observed to insure collection of the most appropriate specimen possible.

As appropriate, review clinical literature; evaluate information from manufacturers for inertness of blood collection containers and specimen contacting transfer pipets & aliquot tubes for any possible analytic interference. All volume specific tubes must be properly filled.

Specimen Size/Sample Size: Without adequate sample size, testing cannot be performed. This inadequate specimen collection is detrimental to patient and patient care. Computer generated labels/ requisitions contain recommended sample sizes, tube type and recommended handling; consult specific departments for questions regarding sample size, minimum sample volumes, specimen handling guidelines for tests not contained in this section. Anatomic Pathology And Cytology

Pathology Specimen Containers

Biopsy specimens submitted to PPLS for analysis must be placed in Buffered Zinc Formalin containers. These can be obtained through your lab courier.

Label the container(s) as outlined in the “Specimen Collection” section. The specimen must NOT be allowed to dry before fixation. Place specimen in container promptly.

¾ Tissue Requisition: To process specimens in a timely and accurate manner, the following information must be provided on the “Tissue Requisition” form: 1) Social Security Number: The patient’s SSN must be included to ensure patient identification. 2) Patient Demographics: Patient’s complete Name, Gender, Date of Birth, Current address and phone number and current insurance information. Please include a copy of the patient’s insurance card (front and back). 3) Section 3 is for “Inpatient use, only”. 4) Clinical Information: Please complete all areas that are related to the tissue specimen being sent. GYN specimens being submitted require any hormone therapy information be included in this section. 5) Clinical History: Include a brief clinical history with all specimens. This provides valuable information for the pathologist as they make their diagnosis. Example: “Pt. has had abnormal bleeding for 3 months; abnormal Pap smear.” 6) Specimens: List anatomical location of all specimens being submitted. 7) Date and time of specimen collection and Name and Address of ordering physician, nurse practitioner, or physician’s assistant.

Cytology Specimens

¾ Cytology Requisition: 1) Patient’s Full Name (Last, First, MI) 2) Current address and telephone number 3) Date of Birth 4) Social Security Number (if able to obtain) 5) Date and time of specimen collection and Name and Address of ordering physician, nurse practitioner, or physician’s assistant. 6) Patient’s current Insurance information including a copy (front and back) of the insurance card. 7) Source of material submitted (cervical, endocervical, vaginal, or other gynecological or non-gynecological site) 8) Patient history or clinical information • Last menstrual period (LMP) • Hormonal status • Hormone therapy • Birth control pills, IUDs • DES exposure • History of abnormal cytology, gynecologic surgeries, cryosurgery, electrocautery or laser surgery. • Date of last gynecologic smear and PPLS accession number, if applicable. • Designate if the patient is at high risk for cervical cancer. History of dysplasia, human papillomavirus infection (HPV), grossly visible lesions, abnormal bleeding, etc.

Gynecologic Cytology Specimen (Pap Smear) Collection and Requirements For the collection of Pap Smears, PPLS uses the SurePath™ Liquid-Based Pap Test. The SurePath™ liquid-based Pap test produces slides that are intended as replacements for conventional gynecological Pap smears for use in the screening and detection of cervical cancer, precancerous lesions, atypical cells, and all other cytologic categories as defined by the Bethesda System for Reporting Cervical Cytology. - Collection Procedure: 1) After explaining the procedure to the patient, gently insert an unlubricated speculum (warm water or saline may be used) into the vagina, avoiding direct pressure on sensitive anterior structures. 2) It is important that an adequate sample not obscured by blood, inflammation, or mucus be submitted. If the transformation zone is obscured by secretions, it should be gently wiped with a gauze pad or cotton tip applicator. (Do not wash cervix with saline) 3) Obtain an adequate sample from the cervix using the Rovers Cervex- Brush ™or the Pap Perfect® plastic spatula and Cytobrush® Plus GT 4) If using the Rovers Cervex-Brush® collection device, insert into the endocervical canal. Apply gentle pressure until the bristles form against the cervix. Maintaining gentle pressure, hold the stem between the thumb and forefinger. Rotate five (5) times in a clockwise direction. Preserve the entire sample by placing your thumb against the back of the brush pad, and simply disconnect the entire brush from the stem into the SurePath preservative vial. 5) If you are using the Pap Perfect™ Plastic Spatula and Cytobrush™ Plus GT collection device, obtain an adequate sampling from the ectocervix using the plastic spatula. Disconnect the spatula head into the SurePath™ preservative vial. Insert the Cytobrush® into the cervix until only the bottom most fibers are exposed. Slowly rotate or turn one half turn in on direction. Do Not Over Rotate. Disconnect the brush head and place in the SurePath® preservative vial. 6) Recap the vial and tighten 7) Label the vial with patient’s complete name, date and time of collection. 8) Complete a purple Cytology requisition with all patient demographics, date of last menstrual period, specimen source and any pertinent clinical history.

State Law 1050(g) requires that the patient name be written on ALL accompanying slide(s) and liquid-based vials submitted for cytological review.

Unacceptable Specimens Specimens are deemed unacceptable when any of the following occur: 1) No patient information on requisition 2) Unlabeled slide(s) or collection vials 3) Patient’s name is different from the requisition and slide(s)/collection vials 4) Slide(s) are broken beyond repair or receipt 5) No source is indicated on non-gyn specimens 6) Incorrect requisition

Cytology Supplies SurePath™ Liquid-Based Pap test specimen collection kit, which includes a SurePath™ preservative fluid collection vial and the sampling devices. Kits may be ordered through PPLS Client Services or simply complete a supply request form.

Quality Assurance PPLS performs all cytopathology procedures in accordance with all state and federal regulations. An intensive internal Quality Assurance program is also followed.

All Pap smears deemed “within in normal limits” by cytotechnologist’s evaluation are rescreened through the FOCAL POINT INSTRUMENT This instrument is FDA approved and has reduced the false negative rate significantly. A statement indicating that the FOCAL POINT EVALUATION has been performed on the patient’s Pap smear will appear on the final report.

Non-Gyn Cytology Specimen Requirements

Breast Secretion Smears: • Label numerous clean slides with patient’s name. Number slides successively by side (R1, R2, etc.; L1, L2, etc) • When a small drop of secretion appears at the nipple, smear and immediately place 95% ethanol fixative. Pap smear fixative of any type is also adequate. • Repeat as long as secretion is obtained because the last drops frequently yield the best-preserved cells. • Properly label the 95% ethanol fixative container with the patient’s first and last name and date and time of collection. • A clinical history MUST be provided on the Cytology requisition.

Sputum Cytology: • A satisfactory specimen is crucial for adequate evaluation. A satisfactory specimen must be a DEEP COUGH specimen. Saliva and nasopharyngeal drainage are not acceptable. Specimens contaminated with a large amount of saliva and food particles are not acceptable. • The first morning DEEP COUGH specimen is considered the most desirable; however, specimens obtained at any other time of the day are equally acceptable. • The specimen should be expectorated into a clear container; a urine specimen cup is ideal. If this material is to be for a culture, the container MUST be sterile. • Properly label the container with the patient’s complete name, requisition ID number, and the date/time of collection. • A clinical history must be provided on the Cytology requisition. • Specimens should be received in the laboratory as soon as possible. If there is any delay, keep the specimen refrigerated. • In general, three (3) to six (6) separate specimens are recommended in order to increase diagnostic sensitivity and accuracy.

Urine Cytology • A clean non-sterile urine specimen container is acceptable unless the specimen is to be submitted for culture, also. In which case, a sterile container must be used. • Approximately 60-80 cc of fresh voided urine should be collected in the container. This should NOT be the first morning specimen. Any other freshly voided specimen is acceptable. Women should be instructed to avoid vaginal contamination. • If there is a delay in sending specimens to the laboratory, store specimens in the refrigerator for not greater than 24 hours. • In general, at least three (3) separate specimens are recommended in order to increase diagnostic sensitivity and accuracy. • Catheterized specimens must be labeled as such on the requisition. • Bladder washings/brushings and arterial washing/brushings should be handled in the same manner, again with appropriate identification of the specimen’s origin. Sterile physiologic fluid such as “Tissue-sol” is recommended as the irrigation fluid. Saline is also acceptable. • A clinical history MUST be provided on the requisition.

Fluids: Pleural and Peritoneal • Body fluid may be collected in tubes, syringes, or clean collection bags. It is recommended that approximately 5 – 10 units of heparin per ml of sample be added to prevent coagulation. • In general, 200 cc of sample is sufficient for evaluation, although larger volumes may provide a better cell block. • Properly label specimen container with patient’s complete name and date/time of collection. • If there is any delay in sending the specimen to the laboratory, it should be refrigerated. • A clinical history must be provided on the requisition.

Cerebrospinal Fluids (CSF) • Place the collected specimen into a sterile CSF collection tube or a plain red top vacutainer tube. (Do Not SST) • A minimum of one (1) cc of fluid is considered the absolute minimum. The larger the volume of specimen, the greater he sensitivity and accuracy. • Properly labeled specimen containers with patient’s name and date/time of collection, is imperative. • Send the specimen immediately to the laboratory. Any delay has a significant negative impact on specimen quality.

¾ Aspiration Cytology Services Palomar Pomerado Laboratory Services is pleased to make available to our clients the valuable service of the interpretation of cytological material performed on outpatients using the fine needle aspiration technique. This interpretative service is available on a routine basis with turnaround times approximately equal to that of routine cervical-vaginal Pap smears.

The following procedures are strongly recommended to obtain well-fixed representative cytologic material from any source: • Label glass microscope slide with patient’s last name, first name and middle initial. • The target lesion is grasped and immobilized with the free hand while the needle position and vacuum are controlled with the other hand. • Using a 22-gauge needle or thinner, insert the tip of the needle through the skin and into the lesion. Local anesthesia is usually not necessary. • Apply full vacuum on the plunger of the syringe now that the needle head is complete within the target area. • Move the needle back and forth within the mass while varying its angle within the lesion. RELEASE THE VACUUM, and withdraw needle from patient. If blood flows into the syringe, stop immediately. • At this point, the cytologic sample should be entirely within the barrel of the needle. To retrieve the sample, first remove the needle from the syringe, and pull back on the syringe plunger to introduce air into the syringe. • Replace the needle on syringe, place tip of needle over a glass microscope slide and depress the plunger. The cytological material will be discharged onto the surface of the slide. • Two (2) smears can be prepared by gently touching two (2) slides together and quickly but gently sliding them apart. Immediate fixation of the smears is of paramount importance. This is accomplished by immediate immersion in alcohol fixative. • If preparation of smears is difficult, we will provide CYTORICH (transfer media), which will support the cellular material until it can be prepared in the laboratory. If using the transport media, follow the directions through step #5. Then aspirate the media into the needle and syringe and rinse them back into the container. Make sure the tip is tight when finished. • Place the “business” side of each slide facing away from each other in the bottle of alcohol. Submit the slides to the laboratory still in fixative. • A clinical history and clinical impression must be provided on the requisition.

™ Re-capping or Re-sheathing used needles is strongly discouraged.

™ The laboratory WILL NOT accept syringes with a bare or exposed needle attached. The specimen will remain in your office until the needle is removed and properly disposed. This is in accordance with OSHA’s Blood-Borne Pathogen regulations. Appendix

Specimen Requirements: Submission Test Requirements / Tube Special Handling Color ABG (Arterial Blood Gas) 1 ml Li Heparin syringe Mix/ ABO typing 7 ml/lavender ABORh 7 ml/lavender ACE (Angiotensin Converting Enzyme) 7 ml/SST Acetaminophen (Tylenol) 5 ml/PST / SST Acetone 5 ml/PST / SST Acetylcholine AB 7 ml/SST Acid Phosphatase (ACP) 5 ml/Plain red Freeze serum ASAP. ACTH (Adrenocorticotropic Hormone) 7 ml/lavender Freeze plasma ASAP. Adenovirus AB 6.5 ml/SST Albumin 5 ml/PST /SST Do not prep site with Alcohol, Ethyl (Ethanol) 5 ml/SST/PST alcohol; use acceptable Aldolase 5 ml/SST Aldosterone 5 ml/SST Freeze serum ASAP. Alkaline Phosphatase 5 ml/PST /SST Alkaline Phosphatase Isoenzymes 6.5 ml/SST Allergy Testing 1 ml serum / SST Special handling. See Alpha-Fetoprotein (AFP - maternal) 3 ml/SST AFP procedures. Alpha-Fetoprotein (AFP - tumor marker) 5 ml/SST Alpha Thalassemia 7 ml/lavender Alpha-1-Antitrypsin 5 ml/SST ALT (SGPT) 5 ml/PST / SST 3 Alpha, 17 Beta Androstanediol 6.5 ml/SST Glucoronide Assay (AG) 7 ml/royal blue - (No Aluminum level Additive Anticoagulant) Amebic AB (CIE) 6.5 ml/SST Amebic AB (IFA) 6.5 ml/SST Amebic AB (IHA) 6.5 ml/SST No SST - Consult policy Amikacin (Amikin) (peak or trough) 10 ml/red regarding pre/post dose. Amino Acid Quantitation 7 ml/green Amitriptyline 10 ml/red No SST. Ammonia (NH4) 3 ml/PST Deliver on ice - STAT. Amoxapine(Asendin) 10 ml/red No SST. Amphotericin 10 ml/red Amphicillin 10 ml/red Amylase 5 ml/PST / SST Amylase Isoenzyme 6.5 ml/SST ANA (Antinuclear antibodies) 7 ml/ SST ANCA (Anti-Neutrohil Cytoplasmic AB) 6.5 ml/SST Ancef 10 ml/red Androstenedione 6.5 ml/SST Freeze serum. Angiotensin-1 Converting Enzyme (ACE) 5 ml/SST ANTI - ANYTHING 6.5 ml/SST (When in doubt.) Anti-Acetylcholine Receptor AB 6.5 ml/SST Antibody Screen 7 ml/lavender Anti-Cardiolipin 6.5 ml/SST Anti-Centromere 6.5 ml/SST Anti-Diuretic Hormone (ADH; 2x7 ml/lavender Freeze plasma ASAP. Vasopressin) Anti-DNA AB (DS) (ADH; Vasopressin) 6.5 ml/SST Anti-DNA AB (SS) 6.5 ml/SST Anti-ENA AB 6.5 ml/SST Anti-GBM AB (Glomerular Basement 6.5 ml/SST Membrane) Anti-HAV IgM(Hep A virus AB, IgM) 6.5 ml/SST Anti-HBC IgM (Hep B virus AB, IgM) 6.5 ml/SST Anti-HCV (Hep C virus AB) 6.5 ml/SST Anti-Histone AB 6.5 ml/SST Anti-MAG (Myelin Associated 6.5 ml/SST Glycoprotein) Anti-Microsomal AB 6.5 ml/SST Anti-Mitochon. AB 6.5 ml/SST Avoid hemolysis. Anti-Neutrophil Cytoplasmic AB 6.5 ml/SST Anti-Parietal Cell AB 6.5 ml/SST Anti-Phospholipid 6.5 ml/SST Anti-Platelet AB Indirect 10 ml/ Plain Red Freeze Serum ASAP Anti-RNP AB 6.5 ml/SST Anti-RO/LA AB(Anti-SSA/SSB) 6.5 ml/SST Anti-SCL 70 AB 6.5 ml/SST Anti-Smooth Muscle 6.5 ml/SST Anti-Sperm AB 6.5 ml/SST Anti-SSA/SSB AB 6.5 ml/SST Anti-Striated Muscle 6.5 ml/SST Anti-Thyroglobulin 6.5 ml/SST Anti-Thyroid AB 6.5 ml/SST AP Isoenzymes(Alkaline Phosphatase) 6.5 ml/SST 3 ml/LT blue (4.5 ml/LT APTT Return to lab ASAP. blue preferred) Arbovirus AB Panel 6.5 ml/SST Arthritis Profile 5 ml/SST & 3 ml/lavender ASO Screen (Anti-Streptolysin) 6.5 ml/SST Aspergillus AB 6.5 ml/SST AST (SGOT) 5 ml/SST AT III (Qual/Quant) (Antithrombin 3) 4.5 ml/LT blue Freeze plasma ASAP. Aventyl 10 ml/red No SST. Freeze serum. B6, Vitamin 10 ml/Lavender B12, Vitamin 5 ml/PST / SST Bacterial Antigen 10 ml/red Barbiturate, Quant 10 ml/red 6 hr URINE collection after Bentiromide (PABA) dose of PABA. Patient must fast over-night. 7 ml/royal blue - (No Beryllium Anticoagulant) or 7 ml/royal blue - EDTA Beta-2-Microglob 6.5 ml/SST Beta HCG Maternal(Human Chorionic 5 ml/SST Gonadotropin) Beta HCG Tumor Marker 5 ml/SST Freeze serum ASAP. Bicarb (arterial) 3 ml/green Do not spin. Bile Acid(Cholylglycine) 6.5 ml/SST Fasting required. Bilirubin, Direct 5 ml/PST / SST Avoid hemolysis. 5 ml/PST / SST Bilirubin, Total Avoid hemolysis.

Blastomyces AB 7 ml/SST Blood Count (CBC - Complete Blood 3 ml/lavender Count) 8-10 ml/BAC T (aer blue Consult Departmental Blood Culture bottle) 8-10 ML/BAC T Procedure for additional

(anaer lav bottle) instructions. 0.5-4 ml/Pedi-BAC T (aer Blood Culture Peds yellow bottle) Special instruct: If 5-8ml Blood Culture collected, add total to grey

aerobic bottle; < 5ml - add total to yellow Pedi. Blood Type (ABORh) 7 ml/lavender Bromide 7 ml/Plain Red Brucella AB 6.5 ml/SST BUN (Blood Urea Nitrogen) 3.5 ml/PST / SST Butabarbital 10 ml/red No SST. C 1 Esterase Inhibitor 7 ml/SST Freeze serum ASAP. CA-15-3 (Cancer Antigen 15-3) 5 ml/SST Freeze serum ASAP. CA-125 (Cancer Antigen 125) 5 ml/SST . CA 27.29 5 ml/SST . Calcitonin 6.5 ml/PST / SST Freeze serum ASAP. Calcium 3.5 ml/SST/PST Calcium, Ionized 3 ml/green lithium heperin Deliver on ice - ASAP. Candida AB 6.5 ml/SST Carbamazepine(Tegretol) 5 ml/PST / SST 7 ml/green or a Carboxyhemoglobin Deliver ASAP to CP. heparinized syringe Cardiolipin Antibody 5 ml/SST Protect from light and Carotene 6.5 ml/SST freeze. Collect on Ice. Freeze Catecholamines,Fractionated 2 x 7 ml/green plasma. CBC (Complete blood count) 3 ml/lavender 10 ml/lavender at room CD4/CD8 temp. CEA (Carcinoembryonic Antigen) 5 ml/SST Ceruloplasmin 6.5 ml/SST Chem 12(Na, K, Cl, Glucose, BUN, Creat, Calcium, T. Prot, Alb, AST, Alk 5 ml/PST / SST Phos, T. Bili Chem + HDL 5 ml/PST / SST Fasting required. Chlamydia Grp(Carcinoembryonic 6.5 ml/SST Antigen) Chloramphenicol (Chlormycetin) 10 ml/Plain Red Freeze serum ASAP. Cholesterol 5 ml/PST / SST Cholinesterase 6.5 ml/SST Cholinesterase, RBC 7 ml/Lavender Do not spin. Chromosome Analysis Child/Adult (Call Central Processing for requirements on 10 ml/SODIUM Heparin Do not spin or refrigerate. infants) Chromosome Analysis (Fragile X) 10 ml/Lavender Do not spin or refrigerate CK (CPK, Creatine Kinase) 5 ml/PST / SST 5 ml/PST / SST CKMB (CK Myocardial fraction)

Cl (Chloride) 5 ml/PST / SST Clonodine 10 ml/Plain red Clonopin(Klonopin, Clonazepam) 10 ml/Plain red Clorazepate(Tranxene) 10 ml/Plain red Cloxicillin 10 ml/Plain red 3 ml/LT Blue (4.5 ml/LT Coagulation tests (PT, PTT, fibrinogen) Blue preferred) CMV PCR(Quant) (Cytomegalovirus) 5 ml Lavender Freeze Plasma CMV, IgG/IgM 6.5 ml/SST Cocci AB 6.5 ml/SST Cocci Panel 6.5 ml/SST Cold Agglutinins 6.5 ml/SST Keep warm Clot for two hours, freeze Complement C 1Q 6.5 ml/plain red serum Freeze serum. Allow to Complement C3 6.5 ml/SST clot at room temperature Freeze serum. Allow to Complement C4 6.5 ml/SST clot at room temperature Clot 1hr @ Rm temp. Complement CH 50(Total) 10 ml/Plain red Freeze serum. Avoid hemolysis. Clot 1hr @ Rm temp. Complement CH 100 10 ml/Plain red Freeze serum. Avoid hemolysis. Coombs, Direct 7 ml/lavender Coombs, Indirect 7 ml/lavender 7 ml/Royal Blue (no Place serum in Trace-free Copper, Serum additive) aliquot tube Cortisol 5 ml/SST Coxsackie A9 or B AB 6.5 ml/SST Acute/Convalescent. CO2 (Bicarb) 5 ml/PST / SST Frozen serum. Fasting C-Peptide 6.5 ml/SST required. C-Reactive Protein 5 ml/PST / SST Freeze Serum; avoid Creatine 5 ml/SST hemolysis. Creatinine 5 ml/PST / SST Patient must be BB Cross-Match (Type and Cross) 7 ml/lavender banded. Store @ room temp 10 ml/red. Draw in pre Cryoglobulins (Quant & Qual) required. Clot one hour at warmed syringe. 37 degree C. Cryptococcus AB 6.5 ml/SST Serum; avoid hemolysis. Cryptococcus Ag 6.5 ml/SST Cyanide 7 ml/green Room Temp. Cyclosporine 10 ml/lavender Do not spin. D-Dimer 3 ml or 4.5 ml/lt blue Deoxycortisol 10 ml/Plain red Depakene Depakote, Valproic Acid) 5 ml/PST / SST Desipramine(Norpramin) 10 ml/red No SST. DHEA -S (Dehydroepiandrosterone-SO4 6.5 ml/SST Freeze serum ASAP. or Sulfate) Diazepam (Valium) 10 ml/Plain Red Dibucaine 6 ml/SST Dicloxicillin 10 ml/red Differential (included in CBC w/Dif) 3 ml/lavender Digitoxin 10 ml/Plain Red Digoxin 5 ml/PST / SST Collect >5hr post dose. Dilantin(Phenytoin, PTN) 5 ml/PST / SST Diptheria AB 6.5 ml/SST Disopyramide(Norpace) 10 ml/Plain red DNA AB DS (Native) 6.5 ml/SST DNA AB SS 6.5 ml/SST Doxepin (Sinequan) 10 ml/Plain red 7 ml/gray and 10 ml/Plain Drug Screen Blood red EBV Panel (Ebstein-Barr Virus) 6.5 ml/SST Echinococcus AB 6.5 ml/SST Echovirus AB 6.5 ml/SST Elavil(Amitriptyline) 10 ml/Plain Red Electrolytes (Na, K, Cl, CO2) 5 ml/PST / SST Erythropoietin 6.5 ml/SST ESR (Erythrocyte Sedimentation Rate; 3 ml/lavender Sed Rate) Estradiol 5 ml/SST Estriol 5 ml/SST Estrogen, Fract 6.5 ml/SST Freeze serum ASAP. Estrogen, Total 6.5 ml/SST Estrone 6.5 ml/SST Freeze serum ASAP. Ethosuximide(Zarontin) 10 ml/red No SST. Ethyl Alcohol 5 ml/Gray Deliver to hospital within Factor Assays 4.5 ml/lt blue 30 min. on ice. Farmer's Lung Screen (Hypersensitivity 7 ml/SST Panel) 2 ml/Special Black top FDP with yellow label Febrile Agglutinins 10 ml/Plain red Ferritin 5 ml/PST / SST Fibrinogen 4.5 ml/lt blue Fifth's Disease (Parvovirus B19) 10 ml/Plain red Flecainide (Tambicor) 10 ml/Plain red Fluoride 10 ml/Plain red Fluoxetine (Prozac) 10 ml/Plain red Folate/Vitamine B12 5 ml/SST/PST Folic Acid 5 ml/PST / SST Obtain HCT before Folic RBC 7 ml/lavender freezing. Do not spin. Freeze whole blood. Francisella AB 10 ml/Plain red Free T3 5 ml/SST Free T4 (Free Thyroxine, FT4) 5 ml/PST / SST Fructosamine 5 ml/SST FSH (Follicle Stimulating Hormone) 5 ml/SST FSH/LH (Follicle Stimulating Hormone / 5 ml/SST Luteinizing Hormone) 2 ml/Special Black top FSP (Fibrin Split Products; FDP) with yellow label FTA AB (Fluorescent Treponemal 6.5 ml/SST Antibodies) Fungal Panel 6.5 ml/SST G-6-PD (Glucose-6-Phosphate 7 ml/lavender or green Do not spin. Dehydrogenase) Galactose-1-Phosphate Uridyltransferase 7 ml/green Do not spin. Gastrin 10 ml/red Freeze serum ASAP. Gentamicin (tr or pk) (Garamycin) 5 ml/PST / SST GGT (Gamma-Glutamyl Transferase) 5 ml/PST / SST Glomerular Basement 7 ml/SST Pre-chill EDTA tubes with Glucagon 7 ml/lavender aprotanin. Freeze plasma. Glucose (Blood sugar) 5 ml/SST / SST / Gray Consult PG 50 collect Glucose, PG 50(post 50 gms Glucola) 5 ml/SST / SST / Gray procedures Glucose, 2 hr PP 5 ml/SST / SST / Gray Collect 2 hrs post meal. Glucose Tolerance test (Specify 3,4,5,6 Consult GTT collection 5 ml/gray ea hour hr) (GTT) procedure Glycine 7 ml/green Freeze plasma. Glycohemoglobin (Glycosylated 7 ml/lavender Do not spin. Hemaglobin A1C) Growth Hormone (HGH) 6.5 ml/SST Haemophilus Influenza Antigen 10 ml/red No SST. Protect from light Haloperidol (Haldol) 10 ml/red during clotting. Haptoglobin 10 ml/red HBSAg 5 ml/SST HCG (Qual or Quant) 5 ml/SST HCG (Tumor marker) 6.5 ml/SST Freeze serum. HCV RNA 10 ml/red Freeze serum. HDL(High Density Lipoprotein) 5 ml/PST / SST Fasting required. HDL/LDL 5 ml/PST / SST Fasting required. Heavy Metals (Quant) 7 ml/royal blue EDTA Do not spin. Helicobacter pylori Ab IgG 10 ml/Plain red Hematocrit (HCT; included in CBC) 3 ml/lavender Hematology tests (CBC, sed rate, retic 3 ml/lavender count) Hemogram (H & H) 3 ml/lavender Hemoglobin ELP 7 ml/lavender Do not spin. Hemophilus Influenza AB 10 ml/Plain red Hepatic Panel (Liver panel) 5 ml/PST / SST Hepatitis Evaluation (or any Hepatitis Must be drawn in 5 ml/SST all = 7 ml/SST testing) separate tube. Hepatitis C RNA/PCR 6.5 ml/SST Freeze ASAP. Herpes AB tests (HSV, Herpes Simplex) 10 ml/red Heterophile Absorp 6.5 ml/SST Hgb A1C (Hemoglobin A1C) 3 or 7 ml/lavender Do not spin. Hgb ELP (Hemoglobin Electrophoresis; 7 ml/lavender Do not spin. Hgb A, C, F, S) Hgb F (Fetal Hemoglobin) (Hemoglobin 7 ml/lavender Do not spin. A1C) HGH (Human Growth Hormone) 10 ml/red H & H (Hemoglobin & Hematocrit - order 3 ml/lavender a Hemogram) Pre-chill tube, Collect on Histamine 7 ml/ Lavender ice Freeze Histoplasma AB, CF 10 ml/red Histoplasma AB, ID 10 ml/red Histoplasma AB, LA 10 ml/red HIV (Human Immunodeficiency Virus) AB 7 ml/ SST -. HIV RNA (Viral Load) 7 ml/EDTA Freeze plasma ASAP. HLA A, B, C 2 x 10 ml/yellow (ACD - A) Room temp. HLA B-27 10 ml/green Room temp. Hydroxyprogesterone 6.5 ml/SST Hypersensitivity Panl (Pneumonitis) 6.5 ml/SST Hypothyroid Profile (T4, TU, FTI, TSH) 5 ml/PST / SST Imipramine 10 ml/red No SST. Immunoglobulins (IgG, IgM, IgA, IgE, 3 ml/red each IgD) Immunoelectrophoresis 6.5 ml/SST . Inorganic Phosphate 5 ml/PST / SST Insulin 5 ml/SST Freeze serum ASAP. Do not draw within 48hrs Intrinsic Factor AB 5 ml/SST of B12 injection.Freeze serum 3 ml/green(not gel tube ) Ionized Calcium Deliver on ice ASAP. /Heparinized syringe Iron 5 ml/PST / SST LA (Lactic Acid) 5 ml/gray Deliver on ice ASAP Lactose 5 ml/gray Fasting required. LAP (Leucine Aminopeptidase) 5 ml/SST Freeze serum L.A.P. Exam (Leukocyte Alkaline 7 ml/NA Heparin Whole blood room temp. Phosphatase stain) LD (Lactate Dehydrogenase; LDH) 5 ml/PST / SST Avoid hemolysis. LD Isoenzyme (LD isos) 5 ml/SST . LDL (Calculated) (See HDL/LDL) 5 ml/PST / SST Fasting required. Lead 7 ml/royal blue EDTA Whole blood. Legionella AB 7 ml/SST Leptospira AB 7 ml/SST 7 ml/EDTA & 2 x 10 Leukemia/Lymphoma Panel Room temp. ml/NaHeparin Leukocyte Alkaline Phosphatase (stain) 7 ml/NA Heparin Whole blood room temp. (LAP Exam) LH (Luteinizing Hormone) 5 ml/SST LH/FSH (Luteinizing Hormone / Follicle 5 ml/SST Stimulating Hormone) Librium (Chlordiazepoxide) 10 ml/Plain red Freeze serum ASAP. Lidocaine(Xylocaine) 10 ml/Plain red Always STAT. Lipase 5 ml/PST / SST Lipid Profile / Panel (includes: 5 ml/PST / SST Fasting required. Cholesterol, Trig, HDL, LDL, Risk Ratios) Lithium 5 ml/SST Liver Function / Panel (ALB, ALK PHOS, 5 ml/PST / SST AST, ALT, T Bili, LD, T Prot) No SST. Freeze serum Ludiomil(Maprotiline) 10 ml/red ASAP. Lupus Anticoagulant 4.5 ml/lt blue Freeze plasma ASAP. Double spin Lupus Panel 10 ml/red Lyme AB 10 ml/red

Lysozyme 7 ml/SST Magnesium 5 ml/PST / SST 7 ml/Royal blue (no Manganese Keep at room temp anticoagulant) Maprotiline (Ludiomil) 10 ml/Plain red Measles Virus AB (Rubeola Virus IgG) 7 ml/SST Meperidine (Demerol) 10 ml/Plain red Mephenytoin (Mesantoin) 10 ml/Plain red Meprobamate (Miltown) 10 ml/Plain red Mercury 7 ml/royal blue EDTA Keep at room temp. Metabolic Screen 20 - 50 ml urine Methaqualone (Quaalude) 10 ml/Plain red Metharbital (Gemonil) 10 ml/Plain red Methemalbumin 10 ml/red Separate serum ASAP. Methemoglobin 7 ml/green Deliver on ice. Methicillin 10 ml/red Protect from light. Freeze Methotrexate 10 ml/red serum ASAP. Methsuximide (Celontin, 10 ml/red No SST. Normethsuximide) Do not use alcohol prep Methyl Alcohol (Methanol) 5 ml/gray to prepare puncture. Metronidazole 10 ml/red MEVACOR Panel 10 ml/red Mexiletine 10 ml/red No SST. Mini Panel (Na, K, Cl, CO2, BUN, 5 ml/PST / SST Creatinine, Glucose) Mono Spot 5 ml/SST Morphine 10 ml/red Keep at room temp. Multiple Sclerosis Panel 10 ml/red & 6 ml/CSF Freeze ASAP. Mumps AB 10 ml/red Indicate if patient is Myasthenia Gravis Eval 7 ml/SST immunosuppressed. Mycoplasma Pneumo (AB / CF or IFA) 7 ml/SST Myelin AB 10 ml/red Myocardial AB 10 ml/red Myoglobin 10 ml/red Mysoline(Primidone) 10 ml/Plain red Na (Sodium) 5 ml/PST / SST Nafcillin 10 ml/red NAPA (N-Acetyl Procainamide - see 5 ml/PST / SST Procainamide) Pre/post dose required; Nebcin (trough or peak) (Tobramycin) 5 ml/PST / SST consult schedule policy. Nembutal (Pentobarbital) 10 ml/Plain red Neomycin 10 ml/red 7 ml/royal blue (No Nickel Keep at room temp. anticoagulant) Nicotine 10 ml/Plain red Keep at room temp. Norfluoxetine 10 ml/red Normethsuximide 10 ml/Plain red Norpace (Disopyramide) 10 ml/Plain red Norpramin (Desipramine) 10 ml/red No SST.. Nortriptyline (Aventyl) 10 ml/red No SST. Novadex (Tamoxifen) 10 ml/red Nucleotidase, 5' 7 ml/SST O2 Saturation (Oxygen % Saturation) 2 ml/Heparinized syringe OB Profile (Includes: HBsAg, CBC, 3ml lavender & 2 6 ml

Rubella, RPR, ABORh, Antibody Screen) SST Osmolality, Serum 5 ml/PST / SST Osteocalcin 6.5 ml/SST Freeze serum ASAP. Oxacillin 10 ml/red Oxazepam (Serax) 10 ml/Plain red Keep at room temp Oxycodone 10 ml/Plain red keep at room temp Pamelor (Nortriptyline) 10 ml/red Pancreatic Islet Cell AB 10 ml/red Pancreatic Polypeptide 6.5 ml/SST Freeze plasma. PAP (Prostatic Acid Phosphatase) 5 ml/SST Freeze serum ASAP Parainfluenza Virus AB (Types 1-4) 10 ml/red Recommend acute/conv. Parathyroid Hormone () 10 ml/red Freeze serum ASAP. Parietal Cell AB 6.5 ml/rSST Draw a red top tube 1st. Partial Thromboplastin Time (PTT, APTT) 3 ml/lt blue Deliver to lab ASAP. Parvovirus AB 6.5 ml/SST No longer done buy the Paternity Testing (Parentage testing - lab. Refer to DNA only) SART/Forensic Dept. pCO2-Arterial 2 ml/Heparinized syringe Pemoline 10 ml/red Pemphigus/Pemphigoid 10 ml/red Penicillin 10 ml/red Pentobarbital (Nembutal) 10 ml/red No SST.Send out STAT Collect specimen 1 hr. PG 50 5 ml/SST post 50 gms glucola. pH-Arterial 2 ml/Heparinized syringe pH-Venous 7 ml/green Phencyclidine (PCP) 10 ml/red No SST. Room Temp. Phenelizine (Nardil) 10 ml/red Phenobarbital (Luminal) 6 ml/red ONLY No SST. Phensuximide 10 ml/red No SST. Room Temp. Phenylalanine (NOT "PKU Newborn 5 ml/green Freeze plasma ASAP. Screening") Phenytoin (Dilantin; Diphenylhydantoin) 6 ml/PST / SST Phosphorus (PO4) 6 ml/PST / SST Phospholipids 6.5 ml/SST Fasting required. Phospholipid Antibody (cardiolipin 5 ml/SST antibody) Piperacillin 10 ml/red PKU (skin puncture) (Phenylketonuria - Fill 5 circles on special

"Newborn Screening") filter paper. Placidyl (Ethylchlorvynol) 10 ml/Plain red Keep at room temp. Double spin. Freeze Plasminogen Activity 4.5 ml/LT blue plasma ASAP. Double spin. Freeze Plasminogen Antigen 4.5 ml/LT blue plasma ASAP. Platelet Circulating AB 10 ml/red Anti-Platelet AB 10 ml/Plain red Freeze serum Platelet IgG Assoc AB (Direct) 10 ml/lavender Keep at room temp. Platelet count (PLT; included in CBC and 3 ml/lavender Hemogram) Check with CP section for Platelet Aggregation special testing requirements. Pneumococcal AB 6.5 ml/SST Collect pre/post inject. pO2-Arterial 2 ml/Heparinized syringe Poliomyelitis Eval(Poliovirus Types 1, 2, 6.5 ml/SST 3 AB) 7 ml/Royal blue no Do not spin. Protect from Porphyrins RBC additivis light. Potassium (K+) 5 ml/PST / SST Avoid hemolysis. Prealbumin 5 ml/PST / SST Pregnancy (Qual) 5 ml/SST Prenatal HbsAg 5 ml/SST Primidone (Mysoline) 10 ml/Plain red Procainamide (Pronestyl; includes 5 ml/PST / SST NAPA) Progesterone 10 ml/red ProInsulin 7 ml/SST Freeze serum Prolactin 5 ml/red Propafenone 10 ml/red Propoxyphene (Darvon) 10 ml/Plain red Keep at room temp. Propranolol (Inderol) 10 ml/Plain red Prostate Specific Antigen (PSA) 5 ml/SST Prostatic Acid Phosphatase 5 ml/SST Freeze serum ASAP Double spin. Freeze Protein C 4.5 ml/ LT blue plasma ASAP. Protein ELP 5 ml/ SSt Double spin. Freeze Protein S 5 ml/ LT blue plasma ASAP. Protein, Total 5 ml/PST / SST Prothrombin Time (PT; Protime) 3 ml/ LT blue Deliver to lab ASAP. 7 ml/Royal blue no Protoporphyrins (Free Erythrocyte; FEP) Do not spin. additive Protoporphyrins (Zinc, ZPP) 7 ml/Royal Blue EDTA Do not spin. Protriptyline (Vivactil) 10 ml/red No SST. Prozac 10 ml/Plain red PSA (Prostate Specific Antigen) 5 ml/SST Pseudocholinesterase 6 ml/SST Psittacosis AB (Chlamydia Trachomatis 10 ml/red IgG AB) PTH 6.5 ml/SST Freeze serum ASAP. Protect from light. Freeze Pyridoxal Phosphate (Vitamin B-6) 7 ml/lavender plasma ASAP. Pre-chill tube. Special Pyruvate 7 ml/green instructions with pyruvate tube Pyruvate Kinase (Erythrocytes) 10 ml/lavander Do not spin Q-Fever AB (Coxiella Burnetti, Phase I/II) 6.5 ml/SSt Quaalude (Methaqualone) 10 ml/Plain red Keep at room temp. Quinidine 5 ml/Plain red RF (Rheumatoid Arthritis) 5 ml/PST / SST Raji Cell Assay (Circulating Immune 6.5 ml/SST Freeze serum ASAP. Complex) Rapid Plasma Reagin (RPR) 5 ml/SST RAST Allergens 1 ml/red per ANTIGEN Make sure to specify RAST Panel 7 ml/red which Allergy Panel is ordered. RBC Count (Red Blood Count; included 3 ml/lavender in CBC & Hemogram) Obtain HCT. Freeze RBC Folate 7 ml/lavender whole blood Consult Send-Out RBC Fragility Department prior to collection. Renal Panel (Na, K, Cl, CO2, Glucose, 5 ml/SST Creat, Uric Acid, Calcium, Phos) Freeze plasma ASAP. Patient must be upright or Renin Activity 7 ml/lavender standing for at least 2 hours prior to draw. Respiratory Syncytial Virus AB (RSV) 6.5 ml/SST Respiratory Virus 6.5 ml/SST Reticulin AB 6.5 ml/SST Reticulocyte Count (Retic) 3 ml/lavender Rickettsial IgG AB (Rocky Mountain 6.5 ml/SST Spotted Fever / Murine Typhus AB) Freeze serum. Draw 1-3 Ritalin 10 ml/Plain red hours post dosage Double spin. Freeze Ristocetin Cofactor 4.5 ml/ LT blue plasma ASAP. RPR (Rapid Plasma Reagin) 5 ml/SST Rubella AB (IgG, or IgM) 5 ml/ SST Rubeola AB IgG (Measles) 5 ml/ SST Salicylate 5 ml/PST / SST Salmonella Agglutin (Febrile Agglutinins) 10 ml/Plain Red Scleroderma AB (SCL-70) 6.5 ml/SST Secobarbital (Seconal) 10 ml/red No SST. Sedimentation Rate (Sed Rate; ESR) 3 ml/lavender 7 ml/royal blue (No Selenium anticoagulant) Room Temperature

Place on ice. Transfer to Serotonin 3 ml/ Lavender special tube and freeze. Sex Hormone Binding Globulin 5 ml/SST SGOT (AST) 5 ml/PST / SST SGPT (ALT) 5 ml/PST / SST Sickle Cell 3 ml/lavender Sjogrens AB (SS-A & SS-B) 5 ml/PST / SST Skeletal Muscle AB 10 ml/red Skin AB (Pemphigus/Pemphigoid AB) 10 ml/Plain red Smooth Muscle AB 7 ml/SST SM RNP (Anti ENA) 7 ml/SST Sodium (Na+) 5 ml/PST / SST 10 ml/Plain red or seminal Sperm AB Panel fluid 10 ml/Plain red or seminal Sperm AB (IgG, IgM, IgA) fluid SSA (RO)(ENA)AB 5 ml/SST SSB (LA)(ENA) AB 5 ml/SST Strep B Antigens 10 ml/red Streptomycin 10 ml/red Streptozyme 6.5 ml/SST Striated Muscle AB 6.5 ml/SST Whole blood. See Sulfhemoglobin 7 ml/lavender procedure. Sulfonamides 7 ml/lavender Tambicor (Flecainide) 10 ml/Plain red Tamoxifen (Novadex) 10 ml/red T-3, Free 5 ml/SST T-3, Total 5 ml/SST T-3, Uptake 5 ml/PST /SST T-4, Free (FT4, Free Thyroxine) 5 ml/PST / SST T-4, Total (Thyroxine) 5 ml/PST / SST TBG (Thyroxine Binding Globulin) 6.5 ml/SST Freeze serum Tegretol (Carbamazepine) 5 ml/PST / SST Teichoic Acid AB 7 ml/SST TdT - Terminal Deoxynucleotidyl 7 ml/sodium heperin Check with Send-Outs Transferase Thyroxine Binding Globulin 5 ml/SST Freeze serum ASAP. Theophylline (Aminophylline) 5 ml/PST /SST Document time last dose. Protect from light. Freeze Thiamine (Vitamin B-1) 7 ml/green plasma. Thiocyanate 10 ml/Plain red No SST. Protect from Thioridazine (Mellaril) 10 ml/red light. Freeze serum. Thiothixene (Navane) 10 ml/red No SST. Freeze serum. Thorazine (Chlorpromazine) 10 ml/red No SST. Thyroglobulin 6.5 ml/SST Thyroglobulin AB 6.5 ml/SST Thyroid Auto AB 6.5 ml/SST Thyroid Microsomal AB 6.5 ml/SST Thyroid Stimulating Hormone 5 ml/PST / SST Thyroxine (T4) 5 ml/PST / SST TIBC (Total Iron Binding Capacity) 5 ml/PST / SST Tissue AB Screen 10 ml/red Peak/trough collection; Tobramycin (Nebcin) 5 ml/PST / SST consult policy. Tocainide (Tonocard) 10 ml/Plain red Protect from light. 2 hr fast Tocopherol (Vitamin E) 6.5 ml/SST required Tofranil (Imipramine) 10 ml/red No SST. Torch Panel (Toxoplasma, Rubella, 6.5 ml/SST Cytomegalovirus, Herpes) Total Bilirubin 5 ml/PST / SST Avoid hemolysis. Total Iron Binding Capacity (TIBC) 5 ml/PST / SST Total Protein 5 ml/PST / SST Toxoplasma AB (IgG, IgM) 6.5 ml/SST Transferrin 5 ml/PST / SST Tranxene (Clorazepate) 10 ml/Plain red Trazodone (Desyrel) 10 ml/Plain red Treponema Pallidium AB by MHA 6.5 ml/SST Triavil (Amitriptyline) 10 ml/Plain red Triazolam (Halcion) 6.5 ml/SST Keep at room temp. Trichinella AB (IgG, IgM) 6.5 ml/SST Tricyclics Screen 10 ml/Plain red Triglycerides 5 ml/PST / SST Fasting required. Triiodothyronine (T-3) Reverse Free or 5 ml/SST Freeze serum. Total Trimipramine (Surmontil) 10 ml/Plain red keep at room temp. Troponin 5 ml/PST / SST Trypsin 7 ml/SST Freeze serum ASAP. 7 ml/Plain red Tryptophan Freeze serum ASAP.

TSH 5 ml/PST / SST Tularemia Antibody 6.5 ml/SSt Avoid hemolysis. Tumor Markers (Dianon) Breast 5 ml/SST Freeze serum ASAP. CA 15-3 5 ml/SST Freeze serum ASAP. CA 19-9 5 ml/SST Freeze serum ASAP. HCG 5 ml/SST Freeze serum ASAP. LASA-P 5 ml/SST Freeze serum ASAP. Leukemia/Lymphoma 5 ml/SST Melanoma 5 ml/SST Freeze serum ASAP. Ovary 5 ml/SST Freeze serum ASAP. Prostate 5 ml/SST Freeze serum ASAP. Uterus 5 ml/SST Freeze serum ASAP. Tylenol (Acetaminophen) 5 ml/PST / SST Typhus (Murine) AB 6.5 ml/SST Urea Nitrogen (BUN) 5 ml/PST / SST Uric Acid 5 ml/PST / SST Urinalysis 1 ml/urine (minimum) Urine Culture 1 ml/urine (minimum) Uroporphyrinogen-1 Synthatase (U1S) 3 ml/lavender Do not spin. Whole blood Valium (Diazepam) 10 ml/Plain red Valproic Acid (Depakene; Depakote) 5 ml/PST / SST Peak/trough collection; consult policy; contact Vancomycin (Vancocin) 5 ml/PST / SST nursing staff prior to collection. VAP 5 ml/SST Varicella-Zoster Virus (VZV) AB 5 ml/SST Contact central processing Vasoactive Intestinal Polypeptide (VIP) special tubes. Vasopressin (ADH; Antidiuretic 7 ml/lavender Critical frozen Hormone) VDRL (RPR) 5 ml/Plain red Velbatol 10 ml/Plain red Verapamil (Isoptin; Calan) 10 ml/Plain red Viscosity 10 ml/red 12 hr fast required. Protect Vitamin A (Retinoids) 7 ml/SST from light.during collection and transport Freeze plasma ASAP. Vitamin B6 (Pyridoxol) 7 ml/lavender Protect from light.during collection and transport Vitamin B12 5 ml/PST / SST Vitamin B12/Folate 5 ml/PST / SST Protect from light. Freeze Vitamin C (Ascorbic Acid) 10 ml/Green plasma. Special Handling Vitamin D (2 kinds: Vit D 25 DH and Vit D 6.5 ml/SST 1,25) 12 hr fast required. Freeze Vitamin E (A, B & Gamma Tocopherol) 10 ml/green serum ASAP. Protect from light. Vivactil (Protriptyline) 10 ml/red No SST. Double Spin. Freeze Von Willebrand Factor Antigen 4.5 ml/lt blue Plasma Double Spin. Freeze Von Willebrand Multimeric Analysis 4.5 ml/lt blue Plasma Double Spin. Freeze Von Willebrand Panel 2 X 4.5 ml/lt blue Plasma WBC (White Blood Count: included in 3 ml/lavender CBC & Hemogram)

Western Blot (in conjunction with HIV) 10 ml/red Xylocaine (Lidocaine) 10 ml/Plain red See procedure regarding Xylose Absorption 5 ml/gray & 5 hr urine scheduling and admin of D-xylose. Yersinia 10 ml/red Zarontin (Ethosuximide) 10 ml/red No SST. 7 ml/royal blue No Zinc Serum Keep at room temp additive Zinc Protoporphyrin (ZPP) 7 ml/royal blue EDTA Protect from light Zoloft 10 ml/Plain red

Critical Values Chemistry:

Test Range Units Nursing Comments Alcohol >350 mg/dl Bili, Indirect >20.0 mg/dl Bili, total (thru 3 months) >15.0 mg/dl Calcium < 6.0 or > 13.5 mg/dl

CO2 < 10 or > 50 mmol/L <40- Per Standardized Procedure Glucose < 40 or > 500 mg/dl >500- Call if treatment have not been initiated.

<30- Per Standardized Procedure Glucose NB (newborn) < 30 or > 300 mg/dl >300- Call if treatment have not been initiated Call if treatment orders have not been Ionized CA < 0.9 or > 1.4 mmol/L initiated Magnesium <1.0 mg/dl >6.9 mg/dl Phosphorus < 1.0 or > 12.5 mg/dl Follow protocol on Section E for procedure POCT Glucose < 40 or > 400 mg/dl “Accu-chek Inform Blood Glucose System"

Potassium < 2.8 or > 6.2 mmol/L Sodium < 120 or >160 mmol/L 1st time result only

Therapeutic Drugs:

Drug Level Range Units Nursing comments Acetaminophen >30 mcg/mL Carbamezepine >15 mcg/mL Prior to next dose ng/mL In the presence of cardiac instability or prior Digoxin >2.2 to next dose Gentamicin Pk >25 mcg/mL Gentamicin Tr >2 mcg/mL Lithium >1.5 mmol/L NAPA >10 mcg/dL Phenobarbital >50 mcg/mL Prior to next dose Phenytoin (Dilantin) >25 mcg/mL Proc + NAPA >30 mcg/dL Procainamide >12 mcg/dL Salicylates >30 mg/dL mcg/dL STAT if continuous infusion or prior to next Theophylline >20 dose Tobramycin Pk >25 mcg/dL Tobramycin Tr >2 mcg/dL Valproic Acid >200 mcg/dL Prior to next dose Vancomycin, Pk. >50 mcg/dL Vancomycin, Tr. >25 mcg/dL

Blood Gases:

Test Range Units Nursing Comments Carboxy hemoglobin > 10 %

HCO3 <10 or >50 mmol/L

HCO3 <1 month old <12 or >40 mmol/L Oxygen saturation <86 % Call only with complete ABG result and pH pCO >60 mm HG 2 less than 7.25 t pCO2 <1 month old < 20 or > 60 mm HG < 7.20 or pH > 7.60 pH <1 month old < 7.25 or > 7.60 pO2 < 50 mm HG pO2 <1 month old < 45 or >200 mm HG

Hematology:

Nursing

Test Range Units Comments

Blasts -to include suspect blast-like cells counted in "other" 10% or category % 1st time result only more -applies ONLY on new patients with no history of leukemia

Gran ABS <0.6 x 1000/mm3 < 19.8 or Hct (pediatric) % >64 < 19.8 or Hematocrit % >70 < 6.6 or Hemoglobin g/dl >23 WBC <1.0 x 1000/mm3 1st time result only

Coagulation

Nursing

Test Range Units Comments

INR > 4.0 If no orders to correct < 20 or > Platelets x 1000/mm3 1st time result only 1000 PT > 35 sec PTT > 150 sec If pre-printed heparin orders not initiated

Microbiology Test Range Comments Malaria smears Any positive Blood Culture Any positive CSF Gram Stain or culture Any positive Gram Stain on any Sterile Body fluid Any positive CSF Latex Antigens Any positive India Ink Any positive Gram stain or culture on visceral organs (ex. lung, liver or brain), tissues, abscesses and Any positive aspirates

Critical Tests The list below is not exclusive and may be updated as more tests and conditions are identified. Critical Tests List Range Comments Lab calls doctors' offices prior to surgery. Any abnormal All abnormal pre-op tests Lab staff see procedure 3220 tests Pre-Admit & Pre-Surgical Review for abnormal test results. Call immediately. If after hours, All confirmed for outpatients (Outreach) HIV tests positive call first thing next business day. Ketones or Clinitest in a newborn Any positive

Stat Tests: Orderable Section Subsection STAT FACILITY ABORh Blood Bank STAT Acetaminophen Level General Lab Chemistry STAT Acetone General Lab Chemistry STAT Albumin Level Blood General Lab Chemistry STAT Alcohol Level Blood General Lab Chemistry STAT Alkaline Phosphatase General Lab Chemistry STAT ALT General Lab Chemistry STAT Ammonia Level General Lab Chemistry STAT Amylase Blood General Lab Chemistry STAT Antibody Screen Blood Bank STAT AST General Lab Chemistry STAT Bilirubin Direct General Lab Chemistry STAT Bilirubin Indirect General Lab Chemistry STAT Bilirubin Total General Lab Chemistry STAT Blood Gas Arterial General Lab Chemistry STAT Blood Gas Arterial Cord General Lab Chemistry STAT Blood Gas Capillary General Lab Chemistry STAT Blood Gas Venous General Lab Chemistry STAT Blood Gas Venous Cord General Lab Chemistry STAT BMP-Mini Panel General Lab Chemistry STAT BNP General Lab Chemistry STAT Body Fluid Albumin General Lab Chemistry STAT Body Fluid Amylase General Lab Chemistry STAT Body Fluid Cell Count General Lab Hematology STAT Body Fluid Chloride Level General Lab Chemistry STAT Body Fluid Creatinine General Lab Chemistry STAT Body Fluid Crystal Exam General Lab Hematology STAT Body Fluid Glucose General Lab Chemistry STAT Body Fluid LD General Lab Chemistry STAT Body Fluid Osmolality General Lab Chemistry STAT Body Fluid pH General Lab Chemistry STAT Body Fluid Potassium Level General Lab Chemistry STAT Body Fluid Protein General Lab Chemistry STAT Body Fluid Sodium Level General Lab Chemistry STAT Body Fluid Specific Gravity General Lab Hematology STAT BUN General Lab Chemistry STAT Calcium Level Blood General Lab Chemistry STAT Calcium Level Ionized General Lab Chemistry STAT Carbamazepine Level General Lab Chemistry STAT Carbon Dioxide Blood General Lab Chemistry STAT Carboxyhemoglobin Blood General Lab Chemistry STAT CBC General Lab Hematology STAT CBC w/ Differential General Lab Hematology STAT Chem Panel General Lab Chemistry STAT Chloride Level Blood General Lab Chemistry STAT CK General Lab Chemistry STAT CKMB General Lab Chemistry STAT Clost difficile tox A/B Ag by EIA Micro STAT PMC Cooximetry General Lab Chemistry STAT Creatinine Blood General Lab Chemistry STAT CSF Cell Count General Lab Hematology STAT CSF Chloride Level General Lab Chemistry STAT CSF Glucose General Lab Chemistry STAT CSF Lactic Acid General Lab Chemistry STAT CSF LD General Lab Chemistry STAT CSF Protein General Lab Chemistry STAT D-Dimer General Lab Coagulation STAT Digoxin Level General Lab Chemistry STAT Du test Blood Bank STAT Electrolyte Panel General Lab Chemistry STAT Eosinophil Count Total General Lab Hematology STAT Estradiol Level General Lab Chemistry STAT POM Fibrin Degradation Products General Lab Coagulation STAT Fibrinogen General Lab Coagulation STAT Fibronectin General Lab Chemistry STAT FSH General Lab Chemistry STAT POM Gentamicin Level Peak General Lab Chemistry STAT Gentamicin Level Random General Lab Chemistry STAT Gentamicin Level Trough General Lab Chemistry STAT GGT General Lab Chemistry STAT Glucose Blood General Lab Chemistry STAT Gram Stain Micro STAT HCG Qualitative General Lab Hematology STAT HCG Quantitative General Lab Chemistry STAT Hepatitis B Surface Antigen General Lab Chemistry STAT POM HIV Rapid 1 & 2 General Lab Chemistry STAT India Ink Micro STAT PMC Influenza A Virus EIA Micro STAT Influenza B Virus EIA Micro STAT Iron Level General Lab Chemistry STAT KOH Micro STAT Lactic Acid Blood General Lab Chemistry STAT LD Blood General Lab Chemistry STAT LH General Lab Chemistry STAT POM Lipase Level General Lab Chemistry STAT Lithium Level General Lab Chemistry STAT PMC Liver Panel General Lab Chemistry STAT Magnesium Level Blood General Lab Chemistry STAT Malaria Smear General Lab Hematology STAT PMC Methemoglobin General Lab Chemistry STAT Mono Screen General Lab Serology STAT Osmolality Blood General Lab Chemistry STAT Ova and Parasites (Direct Mount Only) Micro STAT PMC pH Blood Venous General Lab Chemistry STAT Phenobarbital Level General Lab Chemistry STAT Phenytoin Level General Lab Chemistry STAT Phosphorus Level Blood General Lab Chemistry STAT Platelet Count Automated General Lab Hematology STAT Platelet Function Aspirin General Lab Coagulation STAT PMC Platelet Function Epinephrine General Lab Coagulation STAT Platelet Function P2Y12 (Plavix Inhibiti General Lab Coagulation STAT PMC Potassium Level Blood General Lab Chemistry STAT Procainamide Level General Lab Chemistry STAT Progesterone Level General Lab Chemistry STAT POM Prolactin Level General Lab Chemistry STAT POM Protein Blood Total General Lab Chemistry STAT Protime General Lab Coagulation STAT PTT General Lab Coagulation STAT Renal Panel General Lab Chemistry STAT Respiratory Syncytial Virus by EIA Micro STAT Retic Count General Lab Hematology STAT Rh Typing Blood Bank STAT Rhogam Workup Blood Bank STAT Rotavirus by EIA Micro STAT PMC Salicylate Level General Lab Chemistry STAT Sed Rate General Lab Hematology STAT Sickle Cell Screen General Lab Hematology STAT PMC Sodium Level Blood General Lab Chemistry STAT Strep Gr A Rapid Immunoassay Micro STAT Testosterone Level General Lab Chemistry STAT POM Theophylline Level General Lab Chemistry STAT Tobramycin Level Peak General Lab Chemistry STAT Tobramycin Level Random General Lab Chemistry STAT Tobramycin Level Trough General Lab Chemistry STAT Troponin I General Lab Chemistry STAT TSH General Lab Chemistry STAT IP only Type and Cross Blood Bank STAT Type and Screen Blood Bank STAT Uric Acid Blood General Lab Chemistry STAT Urinalysis Screen Dipstick General Lab Urinalysis STAT Urinalysis Sedimentation Microscopic General Lab Urinalysis STAT Urine Drug Screen (In House Test) General Lab Chemistry STAT Valproic Acid Level General Lab Chemistry STAT Vancomycin Level Peak General Lab Chemistry STAT Vancomycin Level Random General Lab Chemistry STAT Vancomycin Level Trough General Lab Chemistry STAT WBC Smear Micro STAT Wet Mount Micro STAT I.