Requisition Form

Molecular Diagnostics Requisition

Please identify your facility name and the specific type of requisitions you are requesting. Collected specimens can be sent by fast next day delivery service. Turnaround time of results will be 24 hours. Results will be emailed. Please contact if you have any questions or concerns.

COLLECTION INSTRUCTIONS

Preparation for Specimen Collection

1. RespiDx/SinusDx (Nasopharyngeal Specimen collection): Sit up straight with head against the wall, tilt head slightly, insert swab into one nostril straight back (not upwards)along the floor of nasal cavity, saturate the swab by swirling it gently, up to 10 seconds, if needed repeat in the other nostril to get optimal sample. Once done, place swab into the specimen container and close tightly. On transport tube, record the patient information as listed.
   Sterile cup can be used for Sputum Specimen collection.

2. UriDx (Urine): Collect the urine from the patient, Place the sterile swab(s) in the urine for 5 seconds, and place the saturated swab in the dry transport tube and seal, Discord rest of the urine. Any medical notes in the sleeve of the clear specimen bag.

3. GastriDx (stool) Urine: Collect the stool from the patient, Place the sterile swab(s) in the stool for 5 seconds saturate the swab by swirling it gently, and place the saturated swab in the dry transport tube and seal, Discord rest of the stool. Any medical notes in the sleeve of the specimen bag.

4. WoundDx: Place the sterile swab(s)on the wound/pus) for 5 seconds saturate the swab by swirling it gently, and place the saturated swab in the dry transport tube and seal. Any medical notes in the sleeve of the clear specimen bag

5. HemopathDx (Blood): Collect the blood from the patient, Place the sterile swab(s) in the stool for 5 seconds saturate the swab by swirling it gently, and place the saturated swab in the dry transport tube and seal, and discard rest. Any medical notes in the sleeve of the specimen bag

All Specimens must be labelled with :

• The patient’s name

• Date of birth/age

• Date of collection

• Collectors initials

Ship to: