The most current laboratory testing information can be obtained at

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1 About Adventist Lab Partners Reference Laboratory Adventist Lab Partners (ALPs) Reference Laboratory is affiliated with Adventist Health System. Adventist Lab Partners has been a hospital-based laboratory since the early 1900 s, and has expanded its services to include both Outpatient and Reference work. ALPs Reference Laboratory is focused on providing high quality laboratory testing, and customer service offering a personal touch. Laboratory Testing Manual The Laboratory Testing Manual provides a listing of individual assays and test panels, arranged alphabetically. Additionally, turn-around time, CPT codes and specific specimen requirements are also included. Please note that test that appear with a seven digit test code are test performed at ARUP Laboratories. Tests that do not appear with a test code are performed in house. The most current laboratory testing information can be obtained at We have included CPT codes as a quick reference guide to assist our clients. These codes are subject to frequent changes, so please note we may not be held liable for incorrect codes. Please call our Customer Service Department with any questions, at (630) , option 1. Client Services The Customer Service Department is available from 7:30 AM to 9:00 PM, Monday through Thursday, 7:30 AM to 8:00 PM on Friday and from 9:00 AM to 12:30 PM on Saturday. They can be reached at (630) , option 1. Customer Service Representatives are available to phone/fax reports, assess the testing status of a specimen, add on testing to available specimens and receive courier pick-up requests. Our Customer Service Representatives are also available to answer any additional questions. Courier Services Courier service is available Monday through Friday from 7:00 AM to 10:00 PM, and on Saturday from 9:00 AM to 12:30 PM. STAT courier service is also available. To schedule a pick-up, please call Client Services at (630) , option 1. Report/Result Access Adventist Lab Partners Reference Laboratory has a variety of options for obtaining patient reports based on your office preference. Reports can be auto-faxed, delivered through Cypress inbox, and transmitted to select Electronic Medical Record systems including Nextgen. I

2 Submitting Specimens and Ordering Tests Requisition Information The following information must be provided on the requisition form accompanied by the specimen: Name, phone number and address of facility sending the specimen Patient demographics (Name, Sex, Date of Birth, Address, Social Security Number) Billing Information (Client Billing, Insurance, or Patient Bill) Insurance information must be filled out completely. Please submit a copy (front and back) of the insurance card. Diagnosis or ICD-9 Codes Test Information/order from Physician Please PRINT all necessary information. Requisition forms, which are not completely or correctly filled out, may cause incorrect billing or delay in testing/resulting for patient lab work. Please fold the requisition forms in half and place them in the designated pocket of the specimen bag. The specimen will go in the other pocket. Specimen Labeling Each tube or specimen container must have the following clearly PRINTED in ink: Patient Name (First and Last Name) Patient Date of Birth Date and time of collection Type of Specimen and Source of Specimen if applicable Specimen Rejection/Test Cancellation All specimens must be collected, labeled, transported and processed according to procedure. Selecting the container type, volume and special handling requirements needed for analysis before the specimen is collected is essential. If the criteria for these procedures are not met, the specimen may be rejected or the test may be canceled. The following represent some reasons for specimen rejection or test cancellation: Inappropriate specimen type or difficulty in obtaining the specimens (hemolysis, clotted specimens) Insufficient volume for analysis Improperly labeled specimens Inappropriate specimen container Improper specimen transport Specimen that has leaked in transit Specimen that has been sent in expired transport media Incomplete or incorrect test request form; for example, testing not marked Test request without a specimen Specimen without a test request Syringes with needle attached II

3 Add-On/Cancellation As long as there is sufficient volume, and the specimen requirements are correct, tests may be added by calling Customer Service at (630) , option 1. Tests may be cancelled by calling Customer Service provided that a test has not been performed. If a test has been performed, a report will be issued, and the client billed. Changes in Methodology and Fees Adventist Lab Partners Reference Laboratory may change methodologies or fees without prior notification if deemed necessary. We will do our best to inform clients of any changes made to protocol. Referred Tests Adventist Lab Partners Reference Laboratory provides comprehensive laboratory testing to our clients by providing them with our in house testing and access to multiple national reference laboratories. Adventist Lab Partners primarily refers specimens to ARUP Laboratory in Utah. Due to the nature of some specimens, they maybe sent to local laboratories. If you have any questions regarding any test not listed in our manual, or one that is listed as being sent out please call ALPs Customer Service at (630) , option 1. III

4 Microbiology Hours The Microbiology Department is open for service seven days a week, from 7:00 AM to 10:45 PM. After this time, services are restricted to those listed in the STAT list, and will be performed by the night shift technologists. Labeling Specimens and Requisitions All specimens must be labeled with the patient s PRINTED name, date of birth, date and time of collection, and source of the specimen. The accompanying requisition must contain the patient s full name, date of birth, date and time of collection, specific source or type of specimen, and the ordering physician s name. Additional optional information may include diagnosis or special instructions. Note: Please be specific in describing the specimen. Example: right ankle abscess is preferred over abscess or wound. Collect specimens before administering antibiotics if possible. If not, note on requisition what antibiotic was given. Label specimen appropriately, place in a plastic biohazard bag and seal airtight. Place the completed requisition and labels, if any, into the separate side pocket. Specimens collected from different sites or sources must be packaged and ordered separately. Refer to individual specimen type for detailed instruction for proper collection receptacle, storage and transport. Specimen Collection, Requirement, Storage, and Transport For a complete list of Specimen collection, requirement, storage, and transport for Microbiology tests, please refer to the individual test. Examples of specimen collection swabs and vials may be viewed online at under stool collection guide and swab chart. General Guidelines Deliver STAT to Microbiology Department within 30 minutes after collection: Spinal fluid (CSF) Wet mounts for Trichomonas Specimens for STAT Tests, refer to STAT Testing. Duodenal aspirate for Ova & Parasites Gastric Lavage fluid for culture AFB Never Refrigerate (Keep at Room temperature) the following specimens: Spinal fluid (CSF) Blood cultures Specimen for Eye cultures Body fluid specimens; Peritoneal, pleural, pericardial, and joint (synovial) fluids Specimens for Anaerobic cultures Specimen for GC (Neisseria gonorrhoeae) screens Wet mounts for Trichomonas Specimen for Genital cultures Swabs for aerobic culture, anaerobe culture, and fungus culture) Urine collected in culture preservative tube Stool specimen collected in a culture preservative vial and in Ova and parasite preservative vial Catheter tip specimen A paddle prep for Pinworm IV

5 Always Refrigerate the following specimens: Sputum Bronchial or lung wash or bronchial or lung brush Tracheal aspirate Urine collected in a sterile container with no preservative Stool specimen collected in clean container for C diff toxin A/B and Rota Virus Antigen EIA Do Not Allow Specimens to Dry Out: Culturettes or transport swabs; break the ampule at the bottom Tissue, catheter tips, etc.; deliver immediately, or add a small amount of sterile saline (not bacteriostatic), never add formalin to a specimen requested for culture. Exceptions: These Specimens May Be Submitted Dry: Skin, hair, or nails for Fungus culture (submit dry scrapings) Swabs for Rapid Influenza A/B (must be submitted dry on foam tip swab) Swabs for Bacterial Vaginosis Rapid Test and Trichomonas Rapid Test Special Swabs or Transport Media must be used for: Anaerobic cultures: Anaerobic culturettes/swabs (with gel at the bottom). Rapid Strep A Only swabs without gel are acceptable. RSV Antigen Test: Nasopharyngeal swab and put in viral transport media. Rapid Influenzae A/B: Foam tip swab Bacterial Vaginosis Rapid Test: Cotton swab Trichomonas Rapid Test: Sterile Rayon swab Syringes: for discharge fluids, etc. are acceptable. Remove the needle and place a plug on the end. Stains The following stains or smears are included when a culture is ordered: Direct Gram Stain: included in all Bacterial Cultures except: Blood, Throat, Stool, Catheter Tip, Environmental, Nasal, Urine, and Strep Screen. Acid Fast (AFB) Smear: included in all AFB Cultures except AFB Blood Culture which is a send-out test. KOH Prep: included in all Fungus Cultures. STAT Testing Upon request, certain procedures can be performed on a STAT basis. The results are telephoned immediately to the requesting office. The results, along with who was notified, date, and time are then entered into the Lab Information System. The most common tests requested and any special comments are as follows: Acid Fast Smear*: Kinyon stain performed. Bacterial Antigen: Source must be indicated (CSF, urine, or serum). All positives are considered critical. Rapid Strep A: Throat only. Fecal WBC*: Feces only. Gram Stain: Indicate source. India Ink Prep*: For Cryptococcus. KOH Prep: Indicate source. Malaria Smear: Thick and thin smears (Fingerstick preferred). RSV Direct antigen test: Nasopharyngeal swab. Wet Prep: For Trichomonas vaginalis and/or yeast. Rapid Influenza A/B: Foam tip swab. Occult blood* Ova and Parasite Test* ( Direct wet mount only) *Only available STAT during 1 st and 2 nd shift. Test ordered on 3 rd shift will be performed STAT on following shift. V

6 Unacceptable Microbiology Specimens All specimens must be collected, labeled, transported and processed according to procedure. Selecting the container type, volume and special handling requirements needed for analysis before the specimen is collected is essential. If the criteria for these procedures are not met, the specimen may be rejected or the test may be canceled. The following represent some reasons for specimen rejection or test cancellation: General Unacceptable Criteria: Unlabeled, mislabeled or inadequately labeled specimen. Improper specimen for test requested. Insufficient specimen for test requested. Specimen collected on expired swabs. Dry swabs submitted (exceptions: Rapid Influenza A/B, Bacterial Vaginosis Rapid Test, and Trichomonas Rapid Test.) Improper preservative or no transport media for specimens requiring preservative or transport media. Prolonged delivery for specific specimens (see below). Improper handling of specimen (i.e. storage at improper temperature). Non-sterile containers (except for stools) Containers showing leakage or external contamination. Second specimen received on the same day for the same procedure (i.e. urine, sputum, or stool for culture; stool for ova & parasites; throat culture.) Except for culture AFB, specimens collected on the same day but have 8 hours or more different of collection time are acceptable for culture. Specifics Unacceptable Criteria: Swab submitted for culture AFB Sputum specimen evaluated as saliva according to gram stain or wet mount of specimen, Sputum delivered more than 2 hours after collection, unless refrigerated (up to 8 hours). Urine received more than 2 hours after collection, unless refrigerated or in boric acid tubes (up to 24 hours is acceptable if refrigerated or in boric acid). Anaerobic culture submitted on a swab with no gel (except tissue or body fluid which is collected in sterile container.) Anaerobic culture from swab delivered after more than 24 hours. Anaerobic cultures from unacceptable sites, such as intact mucosal surfaces: mouth, throat, vagina, external urethra, anus, nasal passages, urine (unless collected by percutaneous aspiration), sputum (unless collected by percutaneous aspiration), and stool. Stool specimens collected from a patient who is admitted to the hospital more than 3 days are unacceptable for stool culture and ova and parasite test. Tissue/body fluid delivered more than an hour after collection. GC (Neisseria gonorrhoeae) culture submitted on swabs more than 8 hours after collection. Stool specimens not submitted in fixative (SAF or formalin and PVA) for Ova & Parasites and stool specimens submitted more than 1 hour after collection, if liquid; more than 2 hours if formed stool. Stool specimens containing barium, for Ova & Parasites testing (must be 7 days after barium test). Wet mounts ordered on dry swabs. Trichomonas wet mount ordered on a specimen more than 30 minutes after collection. Urine for AFB culture when submitted in boric acid tube. Urine in boric acid tube that does not fill tube to line. Foley catheter tips for culture (the request should be a urine culture). Bacterial culture submitted in Viral Culturette. Submitted to Microbiology lab refrigerated for the following specimens: CSF, Blood culture, Specimen for Eye culture, Peritoneal, pleural, pericardial, and joint (synovial) fluids, Specimens for Anaerobic cultures, Specimen for GC (Neisseria gonorrhoeae) screens, Wet mounts for Trichomonas, Specimen for Genital culture. VI

7 Blood Bank General Information Introduction The Adventist Hinsdale Hospital Blood Bank provides a full range of services. The Blood Bank is staffed 24 hours a day, 7 days a week. The Blood Center is available to make appointments for donor and therapeutic services. Please call (630) for hours or to make and appointment. Blood Center needs to make changes Routine Sample Labeling Requirements All samples sent to the laboratory for testing in the Blood Bank must be properly identified. Each sample must have the following information on the sample tube. Whenever possible PRINT all the pertinent information clearly. Patient s full name. Patient s identification number (medical record number if available). Patient s date of birth. Date and time of collection. Identity of the person drawing the blood sample (initials are acceptable, OPID if available). In the event that the above information is not present, testing may not be able to be completed. A new, properly labeled sample may be required. Mislabeled Specimens Samples that are mislabeled, have missing information, or have no identification cannot be tested. An unlabeled sample with an attached requisition is not acceptable for identification purposes. When it is determined that a sample has been mislabeled, the doctor s office, from which the sample was received, will be contacted and asked to furnish a new, properly labeled, sample. RhoGAM Administration RhoGAM is a sterile solution containing IgG anti-d. It is given to women to prevent the formation of anti-d, which could cause Hemolytic Disease of the Newborn. The injection is given intramuscularly whenever there is a possibility that an Rh-negative woman is carrying an Rh-positive fetus. The injection is administered prophyactically prenatally at 28 weeks gestation, followed by another dose every 12 weeks until termination of pregnancy. A post-delivery injection will be necessary if the baby is Rh-positive. RhoGAM injections are routinely given in the ALPs Blood Center. Patients may call for an appointment. VII

8 Billing Information Client Billing In order to have billing for all or particular patients sent to the individual physician office, or other facility please make sure that the following is provided: Doctor Account (Client) is checked off on the patient requisition Patient demographics are included Client information is included Invoices are mailed out by the 15 th of the following month and payment is expected within 30 days of receipt. Please call our Client Billing Department at (630) with any questions. Patient Billing The patient may be billed directly provided that the following information if provided: Self Pay is checked off on the requisition Patient Demographics are included (Name, Full Address, Date of Birth, Phone Number, SS#, and Responsible Party Information) Patients will be billed through Adventist Hinsdale Hospital Billing Department. If Pathology services are provided a separate bill may be issued from DuPage Pathology Associates. Third Party Billing Adventist Lab Partners (ALPS) Reference Laboratory will bill the patient s insurance company directly provided that the following information is given on the requisition: Bill Insurance is checked off on the requisition Patient Full Name, Address, Date Of Birth, Sex, SS# Insured Name (If Other Than Patient: Relationship to patient, Date of Birth, and SS# of Guarantor is Required) Insurance Company Complete Name and Address Insured Group Number Insured Policy Number Copy of Insurance Card (Front and Back) Diagnosis or Preferably ICD-9 Codes Patients are responsible for any yearly deductibles, co-payments and balance not covered by the insurance company. If Pathology Services are provided a separate invoice may be sent to the insurance company from DuPage Pathology Associates. For a listing of managed care companies, which accept the use of ALPS Reference Lab or consultation services on managed care issues, Please call Patient Financial Services at (630) VIII

9 Medicare/Medicaid Billing If a patient has Medicare or Medicaid coverage, it is imperative that patient requisition forms are filled out completely and correctly. Please be sure that the following information is included on the requisition: Bill Insurance is checked off Patient s full name Patient s full address Patient s gender Patient s date of birth Medicare/Medicaid Number All applicable Diagnosis, preferably ICD-9 Code Copy of insurance card Patient s Social Security Number (this is not always the patient s Medicare number) MSP form (secondary payer information form) Advanced Beneficiary Notice (ABN) form signed by the patient IX

10 Accreditation/Licensure -College of American Pathologists: JCAHO Joint Commission on Accreditation of Health Care Organizations -HEW Clinical Laboratories Improvement Act: 14D Medicare Provider Number: Federal License Number: Public Aid Provider Number: State Of Illinois Please call (630) for copy of Licenses. X

MICROBIOLOGY SPECIMEN COLLECTION MANUAL

Lee Memorial Health System Lee County, FL CLINICAL LABORATORY MICROBIOLOGY SPECIMEN COLLECTION MANUAL ACID FAST CULTURE Specimen Type see Specimen Chart ACID FAST STAIN see Specimen Chart Acid Fast stain