South Bend Medical Foundation, Inc

South Bend Medical Foundation, Inc

<p> SOUTH BEND MEDICAL FOUNDATION FLOW CYTOMETRY 530 North Lafayette Boulevard South Bend, IN 46601-1098 Leukemia / Lymphoma Immunophenotyping Patient Information Sheet Flow Cytometry Department Phone: 574-234-4176 or 800-544-0925, ext. 1282</p><p>Please attach this form to specimen transport container.</p><p>Date: </p><p>Patient Name: </p><p>PATHOLOGIC / CLINICAL DIAGNOSIS: Please include a brief history, pertinent laboratory results and suspected diagnosis.</p><p>Diagnosis/Comment: </p><p>Today’s testing requested on: Peripheral Blood Bone Marrow</p><p>Has patient had a prior bone marrow for this or similar condition? Yes No</p><p>If yes, results of that testing indicate: </p><p>Referring Physician Name: </p><p>Office Phone Number: </p><p>SPECIMEN REQUIREMENTS Peripheral Blood Bone Marrow 1 7 mL ACD Vacutainer (Yellow Top) 1 3 mL ACD Vacutainer (Yellow Top) 1 7 mL EDTA Vacutainer (Purple Top) 1 3 mL EDTA Vacutainer (Purple Top) 3-5 Fresh smears 3-5 Fresh smears</p><p>ACD solution “A / B “refers to the volume of tube collected. Use appropriate tube for volume of sample collected to prevent dilution effect.</p><p>Results of current complete blood count and smear must be included if unable to send EDTA tube.</p><p>LABORATORY USE ONLY SPECIMEN PROCESSING: Route patient information sheet to Flow Cytometry</p><p>981237-6 8-05 lsh</p>

View Full Text

Details

  • File Type
    pdf
  • Upload Time
    -
  • Content Languages
    English
  • Upload User
    Anonymous/Not logged-in
  • File Pages
    1 Page
  • File Size
    -

Download

Channel Download Status
Express Download Enable

Copyright

We respect the copyrights and intellectual property rights of all users. All uploaded documents are either original works of the uploader or authorized works of the rightful owners.

  • Not to be reproduced or distributed without explicit permission.
  • Not used for commercial purposes outside of approved use cases.
  • Not used to infringe on the rights of the original creators.
  • If you believe any content infringes your copyright, please contact us immediately.

Support

For help with questions, suggestions, or problems, please contact us