Client Services Manual

Transcription

1 Diagnostic Innovation Improving Health Client Services Manual [ Revised ]

2 Table of Contents About / Instructions Directory... 2 About Diatherix... 3 Specimen Preparation Instructions... 4 Packaging and Shipping Instructions... 5 Test Catalog Diatherix Eurofins Test Menu ABRx Antibiotic Resistance Panel... 8 Atypical Pneumonia Panel... 8 Bacterial Pneumonia Panel... 8 Bacterial Vaginosis Panel... 9 Bronchitis Panel... 9 Candidiasis Panel... 9 CT + NG + Trichomonas Panel Clostridium difficile (toxin B gene) Ear Nose & Throat Panel FirstPlex Panel Gastrointestinal Panel Helicobacter pylori Panel Group B Streptococcus Herpes Simplex Virus Panel HPV High Risk Typing Panel Infectious Disease Panel Influenza Panel Necrosis Panel Pediatric Respiratory Panel Pharyngitis Panel Pharyngitis Plus Panel Respiratory Infection Panel Rhinosinusitis Panel Sexually Transmitted Disease Panel Skin and Soft Tissue Infection Panel Skin and Soft Tissue Infection Plus Panel Staphylococcus Differentiation Panel Upper Respiratory Infection Panel Urinary Tract Infection Panel Viral Respiratory Panel Collection Procedures General Swab Gastric Biopsy Nasopharyngeal Specimens Nasal Swab Fluid Specimens Sputum or Stool Specimen Swab Rectal Swab Clean Catch Urine (UTI) Vaginal/Rectal Swab (Group B Strep) Endocervical Swab Vaginal Swab Urethral Swab Urine Specimen (STD) Collection Recommendations Supplies / References Tube Selection Reference Client Supplies Sample Supply Order Form Sample Test Requisition Sample Laboratory Report Order Codes for Panels Specimen Source List Client Notes

3 Directory Diatherix Laboratories, LLC 601 Genome Way, Suite 2100 Huntsville, Alabama CLIA Number: 01D CAP Number: Revision Date: President: Jennifer Cart VP of Operations & Laboratory Director: Donald R. Stalons, Ph.D., D(ABMM), MPH Diatherix Eurofins is located in the HudsonAlpha Institute for Biotechnology in Cummings Research Park, Huntsville, AL. Client Services Toll free: Local: Fax: Hours: Holiday Closings: 8:00-5:30 CST Monday - Friday 8:30-5:00 CST Saturday New Year's Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, Christmas Day Compliance Hotline (anonymous): Billing Department Toll free: Fax: Hours: 8:00 5:00 CST Monday - Friday Logistics & Supplies Toll free: (voice mail monitoring until 8:00pm CST) Fax: supplies@diatherix-eurofins.com FedEx : (Press "0" for the first three prompts to reach an operator)

4 About Diatherix Eurofins A unique laboratory providing accurate and actionable results in one day for infectious diseases and antibiotic resistance genes utilizing innovative molecular technologies, including proprietary TEM-PCR. linking diagnostics to therapeutics Diatherix Eurofins Distinctions: Delivers one-day results Identifies bacteria regardless of recent antibiotic use Offers simplicity of single-sample collection Identifies difficult to culture pathogens Yields a high level of sensitivity and specificity Diatherix Eurofins Benefits: TEM-PCR technology is a proprietary, multiplex amplification platform designed to overcome the challenges that exist with conventional laboratory methods. Improved speed and accuracy of laboratory results lead to: Improved patient outcomes Cost reduction and avoidance Reduced antibiotic utilization Increased patient satisfaction Greater clinical value Billing: Billing for laboratory services has become complicated and unpredictable due to the increased number of plans with different co-pays, co-insurance and deductibles. Much like your business, it is difficult to know in advance what a specific insurance plan will cover for a patient, and therefore what may be the patient s responsibility. Diatherix Eurofins is dedicated to assisting patients with billing questions. If a patient requires assistance, please ask them to call our Billing Department at

5 Specimen Preparation Instructions Please read all instructions for collecting and shipping specimens before beginning the collection process: 1. Choose the appropriate Diatherix Eurofins Test Panel. Pages Follow the appropriate specimen collection procedure. Pages 19-24, 32 Specimen collection protocols in this manual are those that are recommended for each of the panels that Diatherix Eurofins offers. Substitution of collection kit components or specimen types must be preapproved by Diatherix Eurofins before the specimen is submitted for testing. 3. Prevent specimen rejection: Make sure the top is seated properly and screwed down tightly on the tube. Label the specimen transport tube with two identifiers. Preferred identifiers are the patient s first and last name and barcode label from the requisition. This name and barcode must match the name and barcode on the requisition.* 4. Fill out all required fields on the requisition. Writing must be legible. 5. Package and ship the specimen and requisition according to instructions. Page 5 * Other examples of acceptable identifiers include: date of birth, hospital number, Social Security number, unique random number. Each of the two identifiers must match on the tube and the requisition. Place barcode on tube vertically as shown above. Requirements for Acceptance of Specimen Specimens must be: appropriate for the test requested. accompanied by a properly completed, legible Diatherix Eurofins Laboratory Request. transported to the lab according to packaging and shipping instructions. in a properly sealed biohazard specimen bag. labeled with two identifiers, preferably with the patient s name and barcode label which matches the requisition. intact, in the proper container and not leaking. in the appropriate specimen transport medium. within the specimen transport stability range of 5 days, at ambient or refrigerated temperature, measured from time of collection to the time of receipt for laboratory testing. (For ThinPrep pap solution, the specimen transport stability range is 30 days.) Clients will be contacted as soon as possible if any issues need to be resolved. Results are typically reported the same day our laboratory receives the specimen

6 Packaging / Shipping Instructions Specimens for all test panels should be shipped at ambient or refrigerated temperature. Each biohazard bag must contain only one patient sample. 1 Place the labeled transport tube in the zippered pouch in the front of the biohazard bag with the absorbent pad. Seal the bag. 1 2 Place the completed Diatherix Eurofins Test Requisition along with the patient face sheet and insurance card copy in the flap pocket (no zipper) in the back of the biohazard transport bag. Verify that the sample tube and the requisition are in the correct pouch: Requisition is located in the back side in the flapped pouch Specimen sample is located in the front side in the zippered pouch Place the biohazard specimen bag(s), each containing only one sample, in the cardboard shipping box. More than one specimen bag may be shipped in the same box. Place the cardboard shipping box into the FedEx UN 3373 Clinical Pak and seal it. More than one box may be placed in the Clinical Pak Apply the barcoded shipping label to the FedEx UN 3373 Clinical Pak. Retain the confirmation label for your records. Call (1-800-GOFEDEX) to schedule a pickup. Listen to the automated system until after it states in a few words please describe what you are calling about. Then, press "0" for the next three prompts to be connected to an operator. State that you have an Express Prepaid Label and provide your address. No other information will be needed. If your package cannot be picked up, it may be placed in a FedEx Drop Box. A FedEx Drop Box can be located by calling FedEx or going to FedEx.com. Do not take this package to a FedEx Office location as they will not accept this type of shipment. 4 5 TIP: For your records, write the pickup confirmation number in the space provided on the confirmation label

7 Diatherix Eurofins Test Menu RESPIRATORY Viral Respiratory: Adenovirus types 3, 4, 7, 21 Enterovirus group Human bocavirus Human coronavirus (4 types) Human metapneumovirus Influenza A - Human influenza Influenza A - H1N1-09 Influenza B Parainfluenza virus types 1, 2, 3, 4 Respiratory Syncytial Virus (A & B) Rhinovirus Bacterial Pneumonia: Acinetobacter baumannii Bordetella pertussis Chlamydophila pneumoniae Haemophilus influenzae Haemophilus influenzae (type B) Klebsiella pneumoniae Legionella pneumophila Moraxella catarrhalis Mycoplasma pneumoniae Neisseria meningitidis Pseudomonas aeruginosa Staphylococcus aureus MRSA 1 PVL 2 gene Streptococcus pneumoniae Atypical Pneumonia: Bordetella pertussis Chlamydophila pneumoniae Legionella pneumophila Mycoplasma pneumoniae Influenza: Influenza A - Human influenza Influenza A - H1N1-09 Influenza B Parainfluenza virus types 1, 2, 3, 4 FirstPlex: Enterovirus group Influenza A - Human influenza Influenza A - H1N1-09 Influenza B Respiratory Syncytial Virus (A & B) Streptococcus dysgalactiae (Group C, G) Respiratory Infection: Adenovirus types 3, 4, 7, 21 Enterovirus group Human bocavirus Human coronavirus (4 types) Human metapneumovirus Influenza A - Human influenza Influenza A - H1N1-09 Influenza B Parainfluenza virus types 1, 2, 3, 4 Respiratory Syncytial Virus (A & B) Rhinovirus Acinetobacter baumannii Bordetella pertussis Chlamydophila pneumoniae Haemophilus influenzae Haemophilus influenzae (type B) Klebsiella pneumoniae Legionella pneumophila Moraxella catarrhalis Mycoplasma pneumoniae Neisseria meningitidis Pseudomonas aeruginosa Staphylococcus aureus MRSA 1 PVL 2 gene Streptococcus pneumoniae Ear Nose & Throat: Acinetobacter baumannii Chlamydophila pneumoniae Enterobacter aerogenes Enterobacter cloacae Haemophilus influenzae Haemophilus influenzae (type B) Klebsiella pneumoniae Moraxella catarrhalis Mycoplasma pneumoniae Proteus mirabilis Pseudomonas aeruginosa Staphylococcus aureus MRSA 1 PVL 2 gene Streptococcus dysgalactiae (Group C, G) Streptococcus pneumoniae Pharyngitis: Adenovirus types 3, 4, 7, 21 Enterovirus group Human coronavirus (4 types) Influenza A - Human influenza Influenza A - H1N1-09 Influenza B Parainfluenza virus types 1, 2, 3, 4 Respiratory Syncytial Virus (A & B) Rhinovirus Chlamydophila pneumoniae Mycoplasma pneumoniae Streptococcus dysgalactiae (Group C, G) ANTIBIOTIC RESISTANCE Pharyngitis Plus: Includes Pharyngitis Panel plus: Arcanobacterium haemolyticum Fusobacterium necrophorum Upper Respiratory Infection or Pediatric Respiratory: Adenovirus types 3, 4, 7, 21 Enterovirus group Human bocavirus Human coronavirus (4 types) Human metapneumovirus Influenza A - Human influenza Influenza A - H1N1-09 Influenza B Parainfluenza virus types 1, 2, 3, 4 Respiratory Syncytial Virus (A & B) Rhinovirus Bordetella pertussis Chlamydophila pneumoniae Haemophilus influenzae Haemophilus influenzae (type B) Moraxella catarrhalis Mycoplasma pneumoniae Streptococcus dysgalactiae (Group C, G) Streptococcus pneumoniae Pediatric Respiratory Panel 8: Adenovirus types 3, 4, 7, 21 Enterovirus group Respiratory Syncytial Virus (A & B) Haemophilus influenzae Moraxella catarrhalis Mycoplasma pneumoniae Streptococcus pneumoniae ABRx Antibiotic Resistance Panel: Detects seventeen gene types associated with resistance to: β-lactams, quinolones, and macrolides. CTX-M Group 1 CTX-M Group 2 CTX-M Group 8/25 CTX-M Group 9 KPC IMP VIM NDM FOX OXA-1 OXA-48 PER VEB GES ermb qnra qnrs

8 Diatherix Eurofins Test Menu GENITAL HEALTH WOUNDS / SKIN & SOFT TISSUE Sexually Transmitted Disease: Atopobium vaginae Chlamydia trachomatis Gardnerella vaginalis Mycoplasma genitalium Mycoplasma hominis Neisseria gonorrhoeae Trichomonas vaginalis Ureaplasma urealyticum CT + NG + Trichomonas: Chlamydia trachomatis Neisseria gonorrhoeae Trichomonas vaginalis Bacterial Vaginosis: Atopobium vaginae Gardnerella vaginalis Mycoplasma genitalium Mycoplasma hominis Ureaplasma urealyticum Herpes Simplex Virus: Herpes Simplex Virus type 1 Herpes Simplex Virus type 2 Candidiasis: Candida albicans Candida glabrata Candida krusei Candida parapsilosis Candida tropicalis HPV High Risk Typing: HPV High Risk types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 67, 68 Group B Streptococcus: Group B Streptococcus (Streptococcus agalactiae) Staph. Differentiation: Staphylococcus aureus MRSA 1 PVL 2 gene Coagulase-negative Staphylococci Staphylococcus epidermidis MRCoNS 3 + Staphylococcal resistance genes * Infectious Disease: Acinetobacter baumannii Citrobacter freundii Enterobacter aerogenes Enterobacter cloacae Enterococcus faecalis Enterococcus faecium Escherichia coli Klebsiella spp. Morganella morganii Proteus mirabilis Proteus vulgaris Pseudomonas aeruginosa Staphylococcus aureus MRSA 1 PVL 2 gene Staphylococcus lugdunensis + Staphylococcal resistance genes * + Vancomycin resistance gene Skin/Soft Tissue Infection: Acinetobacter baumannii Bacteroides spp. Citrobacter freundii Clostridium novyi/septicum Clostridium perfringens Enterobacter aerogenes Enterobacter cloacae Enterococcus faecalis Enterococcus faecium Vancomycin-resistant Enterococci Escherichia coli Kingella kingae Pseudomonas aeruginosa Staphylococcus aureus MRSA 1 PVL 2 gene Staphylococcus lugdunensis Skin/Soft Tissue Infection Plus: Includes Skin and Soft Tissue Infection Panel plus: Klebsiella spp. Morganella morganii Proteus mirabilis Proteus vulgaris + Staphylococcal resistance genes * Necrosis: Bacteroides spp. Clostridium novyi/septicum Clostridium perfringens Kingella kingae Staphylococcus aureus MRSA 1 PVL 2 gene Staphylococcus lugdunensis URINARY TRACT INFECTION GASTROINTESTINAL Urinary Tract Infection: Acinetobacter baumannii Citrobacter freundii Enterobacter aerogenes Enterobacter cloacae Enterococcus faecalis Enterococcus faecium Vancomycin-resistant Enterococci Escherichia coli Klebsiella spp. Morganella morganii Proteus mirabilis Proteus vulgaris Pseudomonas aeruginosa Staphylococcus saprophyticus Gastrointestinal: Campylobacter jejuni Clostridium difficile (toxin B gene) Enterohemorrhagic E. coli (EHEC) - Shiga-like toxin gene (stx1) - Shiga-like toxin gene (stx2) Enteroinvasive E. coli/shigella (EIEC ) Enteropathogenic E. coli (EPEC) Enterotoxigenic E. coli (ETEC) Salmonella enterica Vibrio parahaemolyticus Adenovirus 40, 41 Norovirus Rotavirus Cryptosporidium parvum Giardia lamblia Helicobacter Pylori Helicobacter pylori Clarithromycin resistance determinant * Staphylococcal Resistance Genes Conferring Resistance For: Aminoglycoside (Staphylococcal), Cephalosporin (Staphylococcal), Erythromycin/Clindamycin (Staphylococcal), Methicillin (Staphylococcal), Tetracycline (Staphylococcal) 1 Methicillin-resistant Staphylococcus aureus 2 Panton-Valentine leukocidin 3 Methicillin-resistant Coagulase-negative Staphylococci

9 Diatherix Eurofins Test Panels ABRx Antibiotic Resistance Panel This panel utilizes real-time PCR to detect 17 highly inclusive gene sequences that code for antibiotic resistance. The panel can detect over a hundred individual genetic resistance variants: CTX-M Group 1 CTX-M Group 2 CTX-M Group 8-25 CTX-M Group 9 KPC IMP VIM NDM FOX OXA-1 OXA-48 PER VEB GES ermb 1. Follow the collection procedures outlined on page of this Client Services Manual when submitting wound or urine specimens. 2. To submit an isolate from culture, touch the top of 5 well isolated colonies from a blood agar plate and suspend them in the Puritan Opti-Swab fluid. 3. To screen patients for the presence of multiple gene resistances on admission to the hospital or when entering or leaving a specific location of the hospital, follow the collection procedures outlined for rectal swab collection on page 21. Atypical Pneumonia Panel Bordetella pertussis Chlamydophila pneumoniae Legionella pneumophila Mycoplasma pneumoniae qnra qnrs Bronchial Aspirate Sputum Specimen Swab Nasopharyngeal Aspirate/Wash Nasopharyngeal Swab Bacterial Pneumonia Panel Acinetobacter baumannii Bordetella pertussis Chlamydophila pneumoniae Haemophilus influenzae Haemophilus influenzae (type B) Klebsiella pneumoniae Legionella pneumophila Moraxella catarrhalis Mycoplasma pneumoniae Neisseria meningitidis Pseudomonas aeruginosa Staphylococcus aureus MRSA 1 PVL 2 gene Streptococcus pneumoniae Pleural (Thoracentesis) Fluid Bronchial Aspirate Sputum Specimen Swab Nasopharyngeal Aspirate/Wash Nasopharyngeal Swab Methicillin-resistant Staphylococcus aureus 2 Panton-Valentine leukocidin (PVL) gene 3 Acceptable but not optimal. Proper patient positioning during collection is recommended

10 Diatherix Eurofins Test Panels Bacterial Vaginosis Panel Atopobium vaginae Gardnerella vaginalis Mycoplasma genitalium Mycoplasma hominis Ureaplasma urealyticum Vaginal Swab Urine Specimen (STD) Bronchitis Panel Adenovirus types 3, 4, 7, 21 Human coronavirus (4 types) Human metapneumovirus Influenza A - Human influenza Influenza A - H1N1-09 Influenza B Parainfluenza virus types 1, 2, 3, 4 Respiratory Syncytial Virus (A & B) Rhinovirus Bordetella pertussis Chlamydophila pneumoniae Haemophilus influenzae Haemophilus influenzae (type B) Klebsiella pneumoniae Moraxella catarrhalis Mycoplasma pneumoniae Pseudomonas aeruginosa Streptococcus pneumoniae Bronchial Aspirate Sputum Specimen Swab Nasopharyngeal Aspirate/Wash Nasopharyngeal Swab Candidiasis Panel Candida albicans Candida glabrata Candida krusei Candida parapsilosis Candida tropicalis Vaginal Swab ThinPrep Pap Solution Endocervical Swab Urine Specimen (STD)

11 Diatherix Eurofins Test Panels CT + NG + Trichomonas Panel Chlamydia trachomatis Neisseria gonorrhoeae Trichomonas vaginalis Endocervical Swab Vaginal Swab ThinPrep Pap Solution Urethral Swab Urine Specimen (STD) DISCLAIMER: Multiplex PCR tests (including TEM-PCR) can be used to assess sexual activity and confirm suspicion of the presence of sexually transmitted infections in the routine clinical setting. However, in cases of rape or sexual abuse in children under the age of 15, confirmatory testing (along with appropriate chain of custody as outlined by the CDC) should be performed as recommended by the CDC. NOTE: Certain organisms are intracellular; therefore, there must be enough human cells present to detect the organism. Diatherix Eurofins tests the specimen for human DNA to ensure that an adequate number of cells are present for a valid result. Clostridium difficile Toxin B Gene This assay utilizes TEM-PCR to detect the molecular target that identifies: Clostridium difficile (toxin B gene) Stool Specimen Swab Rectal Swab Ear Nose & Throat Panel Acinetobacter baumannii Chlamydophila pneumoniae Enterobacter aerogenes Enterobacter cloacae Haemophilus influenzae Haemophilus influenzae (type B) Klebsiella pneumoniae Moraxella catarrhalis Mycoplasma pneumoniae Proteus mirabilis Pseudomonas aeruginosa Staphylococcus aureus MRSA 1 PVL 2 gene Streptococcus dysgalactiae (Group C, G) Streptococcus pneumoniae Throat Swab Ear Swab Nasopharyngeal Aspirate/Wash Nasopharyngeal Swab Methicillin-resistant Staphylococcus aureus 2 Panton-Valentine leukocidin (PVL) gene

12 Diatherix Eurofins Test Panels FirstPlex Panel Enterovirus group Influenza A - Human influenza Influenza A - H1N1-09 Influenza B Respiratory Syncytial Virus (A & B) Streptococcus dysgalactiae (Group C, G) Throat Swab Nasopharyngeal Aspirate/Wash Nasopharyngeal Swab Gastrointestinal Panel Campylobacter jejuni Clostridium difficile (toxin B gene) Enterohemorrhagic E. coli (EHEC) - Shiga-like toxin gene (stx1) - Shiga-like toxin gene (stx2) Enteroinvasive E. coli/shigella (EIEC ) Enteropathogenic E. coli (EPEC) Enterotoxigenic E. coli (ETEC) Salmonella enterica Vibrio parahaemolyticus Adenovirus types 40, 41 Norovirus Rotavirus Cryptosporidium parvum Giardia lamblia Stool Specimen Swab Rectal Swab Helicobacter pylori Panel This panel utilizes TEM-qPCR technology to detect molecular targets that identify: Helicobacter pylori Clarithromycin resistance determinant Gastric Biopsy Stool Swab

13 Diatherix Eurofins Test Panels Group B Streptococcus This assay utilizes TEM-PCR to detect the molecular target that identifies: Group B Streptococcus (Streptococcus agalactiae) Collection Procedure: Vaginal/Rectal Swab (GBS) NOTE: It is strongly recommended by the CDC that a vaginal/rectal swab be collected for pregnant women. Cervical specimens are not recommended and a speculum should not be used for swab collection. The Puritan Opti-Swab must be used. Antibiotic susceptibility testing is available for GBS by request. Susceptibility testing can only be performed when the Puritan Opti-Swab tube is used for transport. Specimen stability for susceptibility is two days at ambient or refrigerated temperature. The GBS sample will be inoculated into a broth supplement overnight if negative on the first day it is tested. It will then be tested again the second day after incubation. This is a CDC recommendation. Group B Strep can be performed with the SSTI and the SSTI Plus Panels. Check the box for the Panel as well as the box for Group B Strep. Herpes Simplex Virus Panel Herpes Simplex Virus type 1 Herpes Simplex Virus type 2 General swab (eye, lesion, etc) ThinPrep Pap Solution Urine Specimen (STD) NOTE: Certain organisms are intracellular; therefore, there must be enough human cells present to detect the organism. Diatherix Eurofins tests the specimen for human DNA to ensure that an adequate number of cells are present for a valid result. ThinPrep pap solution is stable for 30 days. HSV Panel can also be tested with the swab specimen or urine specimen collected with the Puritan Opti-Swab to test along with the STD Panel

14 Diatherix Eurofins Test Panels HPV High Risk Typing Panel HPV High Risk types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 67, 68 Endocervical Swab ThinPrep Pap Solution Throat Swab Note: Urine, skin and warty growth specimens are not acceptable (mucosal surfaces only). ThinPrep pap solution is stable for 30 days. Infectious Disease Panel Acinetobacter baumannii Citrobacter freundii Enterobacter aerogenes Enterobacter cloacae Enterococcus faecalis Enterococcus faecium Vancomycin-resistant Enterococci Escherichia coli Klebsiella spp. Morganella morganii Proteus mirabilis Proteus vulgaris Pseudomonas aeruginosa Staphylococcus aureus MRSA 1 PVL 2 gene Staphylococcus lugdunensis Staphylococcal Resistance Genes: Aminoglycoside Cephalosporin Erythromycin/Clindamycin Methicillin Tetracycline General Swab (wound, etc) Synovial Fluid Influenza Panel Influenza A - Human influenza Influenza A - H1N1-09 Nasopharyngeal Aspirate/Wash Nasopharyngeal Swab Throat Swab Bronchial Aspirate Sputum Specimen Swab Methicillin-resistant Staphylococcus aureus 2 Panton-Valentine leukocidin (PVL) Influenza B Parainfluenza virus types 1, 2, 3,

15 Diatherix Eurofins Test Panels Necrosis Panel Bacteroides spp. Clostridium novyi/septicum Clostridium perfringens Kingella kingae Staphylococcus aureus MRSA 1 PVL 2 gene Staphylococcus lugdunensis General Swab (wound, etc) Synovial Fluid Pediatric Respiratory Panel Adenovirus types 3, 4, 7, 21 Enterovirus group Human bocavirus Human coronavirus (4 types) Human metapneumovirus Influenza A - Human influenza Influenza A - H1N1-09 Influenza B Parainfluenza virus types 1, 2, 3, 4 Respiratory Syncytial Virus (A & B) Rhinovirus Bordetella pertussis Chlamydophila pneumoniae Haemophilus influenzae Haemophilus influenzae (type B) Moraxella catarrhalis Mycoplasma pneumoniae Streptococcus dysgalactiae (Group C, G) Streptococcus pneumoniae Nasopharyngeal Aspirate/Wash Nasopharyngeal Swab Bronchial Aspirate Sputum Specimen Swab Pharyngitis Panel Adenovirus types 3, 4, 7, 21 Enterovirus group Human coronavirus (4 types) Influenza A - Human influenza Influenza A - H1N1-09 Influenza B Parainfluenza virus types 1,2,3,4 Respiratory Syncytial Virus (A & B) Rhinovirus Chlamydophila pneumoniae Mycoplasma pneumoniae Streptococcus dysgalactiae (Group C, G) Throat Swab Nasopharyngeal Aspirate/Wash Nasopharyngeal Swab

16 Diatherix Eurofins Test Panels Pharyngitis Plus Panel Adenovirus types 3, 4, 7, 21 Enterovirus group Human coronavirus (4 types) Influenza A - Human influenza Influenza A - H1N1-09 Influenza B Parainfluenza virus types 1,2,3,4 Respiratory Syncytial Virus (A & B) Rhinovirus Arcanobacterium haemolyticum Chlamydophila pneumoniae Fusobacterium necrophorum Mycoplasma pneumoniae Streptococcus dysgalactiae (Group C, G) Throat Swab Nasopharyngeal Aspirate/Wash Nasopharyngeal Swab Respiratory Infection Panel Adenovirus types 3, 4, 7, 21 Enterovirus group Human bocavirus Human coronavirus (4 types) Human metapneumovirus Influenza A - Human influenza Influenza A - H1N1-09 Influenza B Parainfluenza virus types 1, 2, 3, 4 Respiratory Syncytial Virus (A & B) Rhinovirus Acinetobacter baumannii Bordetella pertussis Chlamydophila pneumoniae Haemophilus influenzae Haemophilus influenzae (type B) Klebsiella pneumoniae Legionella pneumophila Moraxella catarrhalis Mycoplasma pneumoniae Neisseria meningitidis Pseudomonas aeruginosa Staphylococcus aureus MRSA 1 PVL 2 gene Streptococcus pneumoniae Nasopharyngeal Aspirate/Wash Nasopharyngeal Swab Pleural (Thoracentesis) Fluid Bronchial Aspirate Sputum Specimen Swab Rhinosinusitis Panel Adenovirus types 3, 4, 7, 21 Human coronavirus (4 types) Human metapneumovirus Influenza A - Human influenza Influenza A - H1N1-09 Influenza B Parainfluenza virus types 1, 2, 3, 4 Respiratory Syncytial Virus (A & B) Rhinovirus Haemophilus influenzae Haemophilus influenzae (type B) Moraxella catarrhalis Staphylococcus aureus MRSA 1 Streptococcus pneumoniae Nasopharyngeal Aspirate/Wash Nasopharyngeal Swab Methicillin-resistant Staphylococcus aureus 2 Panton-Valentine leukocidin (PVL)

17 Diatherix Eurofins Test Panels Sexually Transmitted Disease Panel Atopobium vaginae Chlamydia trachomatis Gardnerella vaginalis Mycoplasma genitalium Mycoplasma hominis Neisseria gonorrhoeae Trichomonas vaginalis Ureaplasma urealyticum Endocervical Swab Vaginal Swab ThinPrep Pap Solution Urethral Swab Urine Specimen (STD) DISCLAIMER: Multiplex PCR tests (including TEM-PCR) can be used to assess sexual activity and confirm suspicion of the presence of sexually transmitted infections in the routine clinical setting. However, in cases of rape or sexual abuse in children under the age of 15, confirmatory testing (along with appropriate chain of custody as outlined by the CDC) should be performed as recommended by the CDC. NOTE: When collecting a urethral swab or a urine specimen from a male or female patient, the patient should not have urinated for at least an hour before the specimen is collected. The first morning urine specimen is preferred due to the large amount of cells usually present. ThinPrep pap solution is stable for 30 days. Certain organisms are intracellular; therefore, there must be enough human cells present to detect the organism. Diatherix Eurofins tests the specimen for human DNA to ensure that an adequate number of cells are present for a valid result. Skin and Soft Tissue Infection Panel Acinetobacter baumannii Bacteroides spp. Citrobacter freundii Clostridium novyi/septicum Clostridium perfringens Enterobacter aerogenes Enterobacter cloacae Enterococcus faecalis Enterococcus faecium Vancomycin-resistant Enterococci Escherichia coli Kingella kingae Pseudomonas aeruginosa Staphylococcus aureus MRSA 1 PVL 2 gene Staphylococcus lugdunensis General Swab (wound, etc) Synovial Fluid Methicillin-resistant Staphylococcus aureus 2 Panton-Valentine leukocidin (PVL)

18 Diatherix Eurofins Test Panels Skin and Soft Tissue Infection Plus Panel Acinetobacter baumannii Bacteroides spp. Citrobacter freundii Clostridium novyi/septicum Clostridium perfringens Enterobacter aerogenes Enterobacter cloacae Enterococcus faecalis Enterococcus faecium Vancomycin-resistant Enterococci Escherichia coli Kingella kingae Klebsiella spp. Morganella morganii Proteus mirabilis Proteus vulgaris Pseudomonas aeruginosa Staphylococcus aureus MRSA 1 PVL 2 gene Staphylococcus lugdunensis Staphylococcal Resistance Genes: Aminoglycoside Cephalosporin Erythromycin/Clindamycin Methicillin Tetracycline General Swab (wound, etc) Synovial Fluid Staphylococcus Differentiation Panel Staphylococcus aureus MRSA 1 PVL 2 gene Coagulase-negative Staphylococci Staphylococcus epidermidis MRCoNS 3 General Swab (wound, etc) Nasal Swab Synovial Fluid Staphylococcal Resistance Genes: Aminoglycoside Cephalosporin Erythromycin/Clindamycin Methicillin Tetracycline 1 Methicillin-resistant Staphylococcus aureus 2 Panton-Valentine leukocidin (PVL) 3 Methicillin-resistant Coagulase-negative Staphylococci

19 Diatherix Eurofins Test Panels Upper Respiratory Infection Panel Adenovirus types 3, 4, 7, 21 Enterovirus group Human bocavirus Human coronavirus (4 types) Human metapneumovirus Influenza A - Human influenza Influenza A - H1N1-09 Influenza B Parainfluenza virus types 1, 2, 3, 4 Respiratory Syncytial Virus (A & B) Rhinovirus Bordetella pertussis Chlamydophila pneumoniae Haemophilus influenzae Haemophilus influenzae (type B) Moraxella catarrhalis Mycoplasma pneumoniae Streptococcus dysgalactiae (Group C, G) Streptococcus pneumoniae Nasopharyngeal Aspirate/Wash Nasopharyngeal Swab Throat Swab Bronchial Aspirate Sputum Swab Urinary Tract Infection Panel Acinetobacter baumannii Citrobacter freundii Enterobacter aerogenes Enterobacter cloacae Enterococcus faecalis Enterococcus faecium Vancomycin-resistant Enterococci Escherichia coli Klebsiella spp. Morganella morganii Proteus mirabilis Proteus vulgaris Pseudomonas aeruginosa Staphylococcus saprophyticus Collection Procedure: Clean Catch Urine Specimen (UTI).. 22 NOTE: The patient should not have urinated for at least an hour before the urine specimen is collected. Viral Respiratory Panel Adenovirus types 3, 4, 7, 21 Enterovirus group Human bocavirus Human coronavirus (4 types) Human metapneumovirus Influenza A - Human influenza Influenza A - H1N1-09 Influenza B Parainfluenza virus types 1, 2, 3, 4 Respiratory Syncytial Virus (A & B) Rhinovirus Nasopharyngeal Aspirate/Wash Nasopharyngeal Swab Throat Swab Bronchial Aspirate Sputum Specimen Swab

20 Specimen Collection Procedures GENERAL SWAB Wound/Abscess Syringe aspiration of purulent material from a loculated, palpable lesion is preferred. 1. The surface of the wound/abscess should be carefully cleansed and debrided using sterile gauze and saline before attempting to aspirate the specimen. 2. Aspirate the specimen and place 0.5 to 1.0 ml of the aspirate directly into the Puritan Opti-Swab transport tube and screw the top on tightly. Open, Draining Wounds, and Decubitus Ulcers 1. Use the Puritan Opti-Swab tube. 2. Cleanse and debride the wound with sterile gauze and saline. 3. Exudate and brushings of the wound base (including advancing margins) should be collected using the swab from the Puritan Opti-Swab. 4. Without contaminating the swab, place the swab into the white top transport tube all the way to the bottom. You may either break the swab at the scored breakpoint indication line or rotate the swab 5 times in the solution and discard the swab. 5. Screw the top tightly on the transport tube. Throat, Ear, Eye, and Dermal (other than Wound, Abscess and Ulcer) 1. Use the Puritan Opti-Swab tube. 2. Open the Puritan Opti-Swab and remove the swab and transport tube, being careful to prevent contamination. 3. Rub the swab on the area to be tested. Any infectious site can be swabbed with the Puritan Opti-Swab for the appropriate panel. 4. Without contaminating the swab, place the swab into the Puritan Opti-Swab tube all the way to the bottom. You may either break the swab at the scored breakpoint indication line or rotate the swab 5 times in the solution and discard the swab. 5. Screw the top tightly on the transport tube. View the Puritan Opti-Swab Training Video for throat swab specimen collection instructions at: GASTRIC BIOPSY 1. Locate visibly suspicious lesions during the esophagogastroduodnoscopy procedure. Biopsies collected from the greater curvature of the antrum are preferred, but other suspicious areas can be biopsied as well. 2. Collect a minimum of two gastric biopsies per patient before collecting specimens that are going to be submitted for histopathology. 3. Place both biopsies for the Helicobacter pylori Panel into the same Diatherix Eurofins gastric biopsy tube. 4. Label the tube with the patient s name and date of birth. 5. Store collected specimens at room temperature prior to being shipped to Diatherix Eurofins

21 Specimen Collection Procedures Nasopharyngeal (NP) Specimens NP Aspirate/Wash The diagnosis of otitis media, sinusitis, and infections of the upper respiratory tract in general is best achieved using a properly collected NP wash/aspirate. 1. Place the aspirate directly into the Puritan Opti-Swab transport tube. 2. Screw the top tightly on the transport tube. NP Swab 1. Use the Puritan Opti-Swab transport tube along with a nasopharyngeal flocked swab (packaged separately). 2. Open the nasopharyngeal swab. Ask the patient to attempt to cough twice, if possible. Then insert the nasopharyngeal swab through one nostril straight back along the floor of the nasal passage until reaching the posterior wall of the pharynx. Rotate the swab for 5 to 10 seconds, leave it in place for a few seconds, and then slowly withdraw. If mucous is not observed on the tip of the swab, repeat the collection procedure in the other nostril to optimize specimen collection. 3. Open the Puritan Opti-Swab and remove the transport tube only. Without contaminating the swab, place the NP swab into the Puritan Opti-Swab transport tube all the way to the bottom and rotate the swab 5 times in the solution. Remove and discard the swab. 4. Screw the top tightly on the transport tube. For a video demonstrating the NP Swab procedure view the Nasopharyngeal Swab Collection Video at Nasal Swab 1. Use the Puritan Opti-Swab. 2. If the patient has nasal discharge, ask the patient to attempt to clear the discharge by blowing his/her nose into non-scented tissue paper. Do not clear the discharge with swabs, as this might be excessively traumatic. Assist children whenever necessary. 3. Remove the swab and transport tube from the packaging. Do not contaminate. 4. Carefully insert the swab into the patient s nostril up to 1 inch from the edge of the nare. 5. Rub the swab 5 times against the surface of the nare. Insert the same swab into the second nostril and roll the swab 5 times against the surface of the nare. Sampling the inside portion of the alar rim is also useful in determining nasal carriage of S. aureus. 6. Without contaminating the swab, place the swab in the Puritan Opti-Swab transport tube all the way to the bottom of the tube. You may either break the swab at the scored breakpoint indication line or rotate the swab 5 times in the solution and discard the swab. 7. Screw the top tightly on the transport tube

22 Specimen Collection Procedures Fluid Specimen Urine (not STD), Synovial Fluid, Bronchial Aspirate, Pleural (Thoracentesis) Fluid, or ThinPrep Pap Solution* 1. Use the Puritan Opti-Swab. 2. Open the Puritan Opti-Swab packaging and discard the swab. Add approximately 1 ml of the specimen fluid to the 1 ml of fluid already in the tube. Do not fill the tube to the top. 3. Screw the top tightly on the transport tube. *ThinPrep Pap Solution ONLY Pour out all of the media solution in the Puritan Opti-Swab tube. Then add approximately 2 to 3 ml of the ThinPrep pap solution to the empty tube. Do not fill the tube to the top. Sputum or Stool Specimen Swab* 1. Use the Puritan Opti-Swab. 2. Remove the swab and transport tube from the packaging. Do not contaminate. 3. Both sputum and stool samples should be carefully examined to identify portions of the specimen (e.g. blood and mucous flecks) that often contain infectious pathogens. These areas of the specimen should be carefully collected by placing the Puritan Opti-Swab tip directly into the representative area identified. 4. Without contaminating the swab, place the swab in the Puritan Opti-Swab transport tube all the way to the bottom of the tube. You may either break the swab at the scored breakpoint indication line or rotate the swab 5 times in the solution and discard the swab. 5. Screw the top tightly on the transport tube. *Stool collection kits are provided by Diatherix Eurofins. Patient collection instructions are included. Rectal Swab (Gastrointestinal Illness) 1. Use the Puritan Opti-Swab. 2. Remove the swab and transport tube from the packaging. Do not contaminate. 3. Insert the tip of the sterile flocked swab approximately 1 inch beyond the anal sphincter. 4. Carefully rotate the swab to sample the anal crypts then withdraw the swab. 5. Without contaminating the swab, place the swab in the Puritan Opti-Swab transport tube all the way to the bottom. You may either break the swab at the scored breakpoint indication line or rotate the swab 5 times in the solution and discard the swab. 6. Screw the top tightly on the transport tube

23 Specimen Collection Procedures Clean Catch Urine Specimen (Not for STD testing) 1. Instruct the patient with the instructions provided below. 2. Follow the Fluid Specimen Collection Procedure (page 21) after obtaining the specimen. 3. Use the plastic transfer pipette to transfer 1 ml of urine from the collection cup into the transport buffer. 1/2 of the transfer pipette volume may be required to transfer the necessary volume of urine specimen (it should not exceed the volume of the buffer already in the tube). Patient Instructions: 1. Wash hands with soap and warm water. 2. Follow gender specific instructions: Females: Spread the labia (folds of skin) apart with one hand and wipe with a towelette. Wipe from front to back. Repeat this process a second time with a fresh towelette. Males: If uncircumcised, retract the foreskin. 3. Follow gender specific instructions: Females: Continue holding the labia apart. As you start to urinate, allow a small amount of urine to fall into the toilet bowl. (This clears the urethra of contaminants.) Do not touch the inside of the collection cup. Males: Wipe the end of the penis with a towelette. As you start to urinate, allow a small amount of urine to fall into the toilet bowl. (This clears the urethra of contaminants). Do not touch the inside of the collection cup. 4. After the urine stream is well established, pass the collection cup into the urine stream. After the cup is ½ full, remove the cup from the urine stream and finish urinating into the toilet bowl. 5. Screw the lid on the cup tightly (do not touch inside of cup or lid). Give the sealed cup to the nurse or attendant. For a video demonstrating the clean catch urine procedure view the Clean Catch Urine Collection Video at Vaginal/Rectal Swab (Pregnancy-related GBS colonization) Vaginal/Rectal swab is the specimen of choice for pregnancy related GBS colonization. 1. Use the Puritan Opti-Swab. 2. Remove the swab and transport tube from the packaging. Do not contaminate. 3. Swab the lower vagina (vaginal introitus), followed by the rectum (insert the swab through the anal sphincter) using the same swab. Move the swab from side to side or rotate the swab at the collection site, allowing a few seconds for the organisms to be absorbed by the swab. Cervical specimens and speculum assisted collections are not recommended. 4. Without contaminating the swab, place the swab in the Puritan Opti-Swab transport tube all the way to the bottom. You may either break the swab at the scored breakpoint indication line or rotate the swab 5 times in the solution and discard the swab. 5. Screw the top tightly on the transport tube

24 Specimen Collection Procedures Endocervical Swab Although non-infectious cervicitis can occur from chemical irritation or malignancy, the majority of causes are infectious pathogens such as Chlamydia, Neisseria gonorrhoeae, Herpes Simplex Virus (HSV) or Human papillomavirus (HPV). Symptoms of cervicitis include inflammation characterized by visible, purulent or mucopurulent endocervical exudate. 1. Use the Puritan Opti-Swab. 2. Remove the endocervical swab from the packaging being careful not to contaminate the swab by touching it to any surface. 3. Insert the flocked tip of the specimen swab into the endocervical canal. 4. Gently turn the swab and allow it to absorb the secretions of the endocervix. 5. Withdraw the swab carefully to avoid contamination. 6. Without contaminating the swab, place the swab into the Puritan Opti-Swab transport tube all the way to the bottom and rotate the swab 5 or more times in the solution to elute any diagnostic material from the flocked swab. Break the swab at the scored line on the shaft and discard the swab after eluting the diagnostic material into the transport medium in the tube. 7. Recap the transport tube carefully to ensure that the cap seals tightly. Vaginal Swab A vaginal swab is the appropriate specimen if a characteristic discharge is present. When ulcerations suggestive of Herpes are seen, careful attention should be given to swabbing the base of the ulceration as well as collecting any secretions that are present and representative of the patient s symptoms. 1. Use the Puritan Opti-Swab. 2. Remove the swab from the packaging being careful not to contaminate the swab by touching it to any surface. 3. Insert the tip of the specimen swab about two inches (5 cm) into the opening of the vagina. 4. Gently rotate the swab for 5 to 10 seconds against the sides of the vagina to ensure adequate sampling. Secretions from the vaginal vault may also contain diagnostic material that is representative of the infectious process (the same swab can be used to collect these secretions). Gently rotate the swab for 15 seconds to ensure adequate sampling. 5. Withdraw the swab carefully. 6. Handle the cap and tube carefully to avoid contamination. 7. Without contaminating the swab, place it into the Puritan Opti-Swab transport tube all the way to the bottom and rotate it 5 or more times in the solution to elute any diagnostic material from the flocked swab. Break the swab at the scored line on the shaft and discard the swab after eluting the diagnostic material into the transport medium in the tube. 8. Recap the transport tube carefully. Ensure that the cap seals tightly

25 Specimen Collection Procedures Urethral Swab (MALE OR FEMALE) Symptoms of urethritis include urethral discharge, dysuria, urethral pruritus, or vague complaints. 1. The healthcare provider uses sterile cotton or gauze to clean (gently wipe) the opening of the distal urethra. 2. Using the Puritan Opti-Swab transport tube, gently insert the swab about ¾ inch into the urethra and turn to capture exudate and dislodge urethral cells that may harbor intracellular organisms. 3. Remove the swab from the urethra and place it into the Puritan Opti-Swab transport tube, rotate the swab 5 or more times in the solution to elute any diagnostic material from the flocked swab. Break the swab at the scored line on the shaft and you may discard the swab after eluting the diagnostic material into the transport medium in the tube. Urine Specimen (STD) Female Symptoms may often be vague where both urethritis and vaginitis are present. If multiple etiologies are suspected, a dirty" urine collection that incorporates the contents of the urethra as well as the wash-off of the labia and vaginal introitis may be useful. Do not use any wipes to cleanse the external genital surfaces before collecting the specimen. 1. Using a sterile, plastic, preservative-free collection container, collect the voided urine specimen by allowing the urine to flow over the external genitalia during the collection. Do not overfill the collection container. 2. Open the Puritan Opti-Swab and discard the collection swab. 3. Unscrew the Puritan Opti-Swab transport tube taking care not to spill the transport buffer. Handle the cap and tube carefully to avoid contamination. Withdraw the swab carefully to avoid contamination. 4. Use the plastic transfer pipette to transfer 1 ml of urine from the collection cup into the transport buffer. half of the transfer pipette volume may be required to transfer the necessary volume of urine specimen (it should not exceed the volume of the buffer already in the tube). Recap the transport tube carefully to ensure that the cap seals tightly. Male Symptoms include urethral discharge, dysuria, urethral pruritus, or vague complaints. 1. Using a sterile, plastic, preservative-free collection container, collect the initial 5-10 ml segment of the first morning void. If the first morning void cannot be obtained, collect a 5-10 ml voided specimen at least one hour from the previous void. 2. Open the Puritan Opti-Swab and discard the collection swab. 3. Unscrew the Puritan Opti-Swab transport tube taking care not to spill the transport buffer. Handle the cap and tube carefully to avoid contamination. 4. Use the plastic transfer pipette to transfer 1 ml of urine from the collection cup into the transport buffer. Half of the transfer pipette volume may be required to transfer the necessary volume of urine specimen (it should not exceed the volume of the buffer already in the tube)

26 Collection Recommendations Preferred Collection Methods STDs, Bacterial Vaginosis, Candidiasis To assist in the accurate diagnosis of genital infections, proper specimen collection should focus on the patient s symptoms. The preferred specimen collection for females with suspected vaginal infection, cervitis or urethritis is an endocervical swab or swab of the exudate. For males, the preferred specimen collection is a swab of the urethra. The use of a properly collected urine specimen may also be valuable as an alternate method when patient tolerance of the swab collection is an issue. The initial segment of a properly collected first morning void is a well validated method to obtain specimens that are useful for the diagnosis of urethritis. When there is sufficient exudative material visible upon examination, a urine specimen that flows over the external genitalia may capture the exudate. When there are visible ulcerations in suspected Herpes infections, a carefully and properly collected swab of the lesion is preferred. A urine collection in females can be useful if the flow successfully captures fluids from ulcerations. In males, however, urine flow may not always allow the capture of Herpes from ulcerations that are not located in the path of urine void. This is particularly so if the ulceration is not associated with foreskin or contiguous with the urethra. Upper Respiratory Tract (Otitis Media, Rhinitis, and Acute Sinusitis) To avoid invasive techniques, such as tympanocentesis and imaging guided percutaneous aspiration of sinus cavities, properly collected nasopharyngeal swabs or aspirates are useful methods of collecting upper respiratory tract specimens. Proper positioning of the patient (supine with head tilted to the posterior) will allow the insertion of the collection device (catheter for collection of NP washes or a flocked swab) into the nasopharyngeal pool that accumulates the drainage of the eustation tube, the sinus cavities, and to a lesser extent, the posterior pharynx. Swabs should be left in contact with the NP pooled secretions to absorb as much diagnostic material as possible. Lower Respiratory Tract (Bronchitis and Pneumonitis) The accurate diagnosis of lower respiratory tract infection is dependent upon the quality of the specimen collected. Several methods have been employed to screen sputum specimens and to improve the reliability of lower airway collections using bronchial washing or specimens obtained via bronchoscopy. Lower respiratory secretions obtained via sputum collection, bronchial alveolar lavage, bronchoscopy, transtracheal aspiration or Pleural (Thoracentesis) Fluid that are optimized to reduce the likelihood of oropharyngeal contamination are preferred. The diagnostic yield of sputum specimen collections can be improved by thoroughly rinsing the oropharyngeal cavity with water before instructing the patient to produce a deep cough specimen. Many patients are unable to provide a proper sputum specimen and induction techniques with the assistance of respiratory therapists may be required. Suctioning of lower airway secretions can also be considered. Pharyngitis The sensitivity of any test used to rule out the presence of Group A Streptococcal Pharyngitis is dependent upon a properly collected swab obtained from the posterior pharynx and tonsils. Although the majority of pharyngitis cases are viral in origin, ruling out the presence of Group A Strep is essential. Proper visualization of the posterior oropharynx is required to identify areas of inflammation and exudate that may be present. Depression of the tongue and careful introduction of the swab to the site of inflammation is an important part of the collection technique that avoids contamination of the specimen with oral secretions

27 Tube Selection Reference Panel Specimen Containers Puritan Opti-Swab Tube Biopsy Collection Tube ABRx Atypical Pneumonia Bacterial Pneumonia Bacterial Vaginosis Bronchitis C. difficile Toxin B gene Candidiasis CT + NG + Trichomonas * FirstPlex Ear Nose & Throat Gastrointestinal H. pylori Group B Streptococcus Herpes Simplex Virus HPV High Risk Typing Infectious Disease Influenza Necrosis Pediatric Respiratory Pharyngitis Pharyngitis Plus Respiratory Infection Rhinosinusitis Sexually Transmitted Disease * Skin and Soft Tissue Infection Skin and Soft Tissue Infection Plus Staphylococcus Differentiation Upper Respiratory Infection Urinary Tract Infection * Viral Respiratory Puritan Opti-Swab Tube Gastric Biopsy Tube * Fluid specimens (including urine for UTI or STD testing) should be added directly to the Puritan Opti-Swab tube. Volume should be approximately 1 ml or equal to the volume of the transport media. Do not overfill the tube

28 Client Supplies 1 Puritan Opti-Swab 1 ml Liquid Amies Transport Medium 6" Sterile Elongated Flock Swab Nasopharyngeal Flocked Swab is available by request Disposable Transfer Pipet 3 Gastric Biopsy Tube 3 4 b 4 Tissue Transfer Tool 5 Patient Take Home Stool Collection Kit English/Spanish Patient Instructions Latex Free Glove Biohazard Bag Absorbent Pad Puritan Opti-Swab With Elongated Flocked Swab 5 6 Stool Collection Device 7 FedEx UN3373 Clinical Pak Prepaid FedEx Label 9 Laboratory Request Form Specimen Shipping Box

29 Client Supply Ordering Notes Client supplies can be easily ordered online at: They can also be ordered via phone, fax or . (See page 2 for Logistics & Supplies contact information.) Your CLIENT ID is required to use this form. Your CLIENT ID can be located on your Diatherix Eurofins Laboratory Request form next to your company name