Labeling, Requistition and Collection Instructions

The Division of Anatomic Pathology requires the submission of a completed Anatomic Pathology Requisition for each tissue specimen or group of tissue specimens submitted for evaluation.

1. Each Anatomic Pathology Requisition must be legible and include the following information:

a. Patient Identification (either stamped or legibly handwritten at top of requisition) must include at least:

1. Patient's Name

2. Medical Record Number/Unit Number

3. Date of Birth

b. Name or designation of Unit/Ward/Clinic submitting specimens.

c. Name and PI # of Attending Physician.

d. Name and PI # of Requesting Physician/Surgeon

e. Name and Pager number of Requesting Physician/Surgeon.

f. Date/Time of specimen collection.

g. Pre-Operative and Post-Operative Diagnoses.

h. Relevant clinical information.

i. Legible, specific and concise anatomic description of each specimen.

j. Name or designation of Unit/Ward/Clinic where written report is to be sent.

k. Special requests or instructions, such as:

1. Cultures

2. Special stains

3. Save specimen for "Dr 's Research Project

2. An example of a Anatomic Pathology Requisition is located in section titled Test Order Forms.

3. Specimens submitted without requisition or with incomplete requisition may be returned to submitting area for corrective action.

4. For telephone assistance or to schedule in-service training in completing Anatomic Pathology Requisitions, please call (916) 734-2525.

The Division of Anatomic Pathology requires each tissue multiple specimens from one patient to be properly labeled.

1. Each Anatomic Pathology specimen label must include the following information:

a. Addressographed label or legible handwritten label with:

1. Patient's Name

2. Medical Record Number/Unit Number

3. Date of Birth

b. Name or designation of Unit/Ward/Clinic submitting specimen.

c. Name and PI # of responsible physician.

d. Multiple specimens from the same operative procedure are designated as letters "A", "B":, etc. Each specimen must be listed with a precise description of the anatomic site.

e. A number/letter designation corresponding to the number/letter designation on the Anatomic Pathology Requisition.

2. Specimens submitted without a label or with incomplete or illegible information may be returned to submitting area for corrective action.

3. For telephone assistance or to schedule in-service training in completing Anatomic Pathology specimens labels, please call (916) 734-2525.

Anatomic pathology results can be obtained by contacting the Pathology Office at (916) 734-2526 Monday through Friday from 0730 to 1700. The patient's medical record number and full name are necessary in order to obtain anatomic pathology results.

All specimens must meet criteria as defined by the laboratory to be accepted for testing. As a general rule, blood and urine specimens that arrive in the laboratory unlabelled will be discarded. THERE WILL BE NO RETROSPECTIVE IDENTIFICATION PERMITTED.

SPECIMEN LABELLING DATA REQUIRED:

1. Patient family name and individual name.*

2. Unique patient identification number (8 digits).*

3. Date and time of collection, the collector's initials.

4. For Blood Bank specimens, the collector's name is mandatory.

REQUISITION DATA REQUIRED:

1. Patient family name and individual name.*

2. Unique patient identification number (8 digits).*

3. Ordering physician index number.

4. Ward or clinic routing or address.

5. Test requested.

6. Date and time of collection.

7. Collectors identification.

8. Gender (M/F).

9. Source or type of specimen.

* UCDMC DOE policy is acceptable as substitute.

Specimen container and test requisition must be received together and the label must match the requisition exactly.

If more than one container must be used (e.g., two jugs for a 24-hour urine collection) label as l of 2 and 2 of 2, to be sure they stay together. LABELING OF SPECIMENS MUST BE DONE BY THE PERSON OBTAINING THE SPECIMEN OR BY SOMEONE WITNESSING THE ACT.

STOOL COLLECTIONS (24, 48, 72 HOUR)

Patient Preparation:

Explain procedure to patient. Include instructions on:

a. Collecting urine separate from feces.

b. Saving all urine and feces.

c. Not mixing any foods together; only eating food provided/approved by dietician.

For specific instructions for collecting Send Out Stool Collections, call (916) 734-0500.

SPOT URINE COLLECTION INSTRUCTIONS

Clean Catch Instructions:

1. Instruct patient on how to best collect urine for a Urinalysis or urine culture:

Cleanse yourself with towelettes as follows:

Male:

Wipe head of penis in a single motion with first towelette. Repeat with second towelette. If not circumcised, hold foreskin back before cleansing. Urinate a small amount into toilet or bedpan. Proceed to step 4.

Female:

Separate the labia. Wipe inner labial folds front to back in a single motion with first towelette. Wipe down through center of labial folds with second towelette. Keep the labia separated and urinate a small amount into toilet or bedpan. Proceed to step 4.

4. Place cup under stream and continue to urinate into cup and collect specimen.

5. Finish voiding into toilet or bedpan.

6. Replace cap on cup. Tighten cap securely. DO NOT REMOVE LABEL FROM CAP.

2. Provide appropriate specimen container and towelette:

a. Vacutainer Urine Collection Kit for urine culture and other miscellaneous spot urine test.

b. Urine container with cap and collection cup.

3. Avoid contamination, DO NOT TOUCH inside of cup or cap.

URINE COLLECTION (24 HOUR)

Collection Instructions:

24 HOUR URINE COLLECTION INSTRUCTIONS

Patient Name:

Patient height:

Patient weight:

***CAUTION***

MAY CONTAIN STRONG ACID - CAN BURN

OR INJURE IF SPILLED ON SKIN

DO NOT VOID DIRECTLY INTO CONTAINER!!!

To Collect Timed Urine Samples: