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1. PLATELET PHERESIS RH IMMUNE GLOBULIN FUSION GIVEN 285265 DATE TIME SIGNATURE STARTED mi ag RECEIVED STOPPED E dz RETURNED REACTION NO YES TYPE OF REACTION 0 CHILLS UDYSPNEA oc2pro PLIT NUMBER UNAUSEA 0 HEADACHE LJAUNDICE SHOCK DITCHING O BACKACHE Grource 5 U m zoo9 LAB USE RESUABLE ORASH OTHER Oorzmrou ONLY DISCARDED SIGNATURE Ez5romr 18 Los Alamos Medical Center Laboratory Computer Downtime Requisition Form Patient Name Date of Birth Date Account if available Patient Location Labs should be Drawn Date Time Ordering Physician Practitioner Ordering Department Priority Routine Timed ASAP STAT Diagnosis Information Laboratory Procedures Requested Please print clearly Person Completing Request Phlebotomist Date Time 19 Criteria for the Acceptance Rejection of Laboratory Specimens Acceptance Policy e patient s full name and a second identifier MR or Date of Birth are required e A written order from the physician that has been filled out properly and signed by the physician is needed Specimen Rejection Criteria Blood e Any specimen received which is not labeled with the patient s full name date of birth date and time drawn and collector s initials e Any specimen for crossmatch which does not have a Blood Bank Identification number on it matching the wrist band on th2. ANTI CELLS Rh TYPE DATE ABO Rh A B AB a b D D Du Du cont cont TECH 3 For a Type and Screen check this box 4 Fora Crossmatch check this box and indicate the 5 Check the box next to the product being requested number of units requested 17 BLOOD BANK 2 A Blood Bank 2 form must be submitted for each unit ordered 1 Place a sticker on each page of the requisition in this area or fill out the requested information LOS ALAMOS MEDICAL CENTER BLOOD BANK 2 TRANSFUSION RECORD CHART COPY PATIENT NAME MEDICAL RECORD DATE OF BIRTH If blood must be given as emergency without crossmatch call blood bank BEFORE GIVING BLOOD HAVE 1 verified the patient s name and hospital no and PATIENT TYPE matched them with the name and no on this slip and on the blood bag IF NOT USED WITHIN TWENTY MINUTES RETURN UNIT DIRECTLY z v 5 E 5 2522 5504 PERO Wo lt Tuis 2F J0 z Ze we Er20 Z5o t OF AnD az gu E WRIST TAG DONOR NUMBER 2 matched donor no wrist tag no ABO and Rh type on the blood E 2 gt bag with donor wrist tag and Rh type on this slip 9 E ar as well as wrist tag patient u o z ME Ah SIGNATURE R N 9 E S3zZ EE lt 4 92554 SIGNATURE R N 2449 E RED CELLS FRESH FROZEN PLASMA TRANS DATE TIME TEMP PULSE BP RN AMOUNT V
3. EE Results 0 V73 81 Special screening for human papillomavirus HPV O V74 5 Special screening for Results venereal disease History of biopsy date i 16235 Vaginal di SPECIAL INSTRUCTIONS 3 Dilaser Cryo O Abnormal bleeding 5 Vaginal discharge y CBCP O Postpartum Ct 623 0 Vaginal dysplasia VAIN I and II NON GYNECOLOGIC CYTOLOGY OlCervicitis Pregnant O V76 47 Vaginal Pap smear status post ElColposcopy Postmenopausal hysterectomy for non mallgnant OlCone LEEP OSupracervical condition DLow DHigh O Hormones hysterectomy A 616 10 Level of Radiologic Suspicion OVaginitis O Total hysterectomy Other HM Source Level of Clinical Suspicion Vaginitis and vulvovaginitis LABORATORY USE ONLY PATHOLOGIST 16 BLOOD BANK 1 When ordering a Type and Screen or a Crossmatch on a patient the following form s must be submitted to the laboratory The shaded areas need to be filled out appropriately 1 Place a sticker on each page of the requisition 2 Fill in the appropriate information In this area or fill out the requested information TRANSFUSION REQUISITION Di LN COLLECTION DATE TIME TECH THIS AREA LAB USE ONLY DONOR amp DONOR TYPE XMATCH RESULTS C COMPATIBLE I INCOMPATIBLE ABO Rh TYPE amp Rh DAT Direct Combs ANTIBODY SCREEN 1 FETAL SCREEN PATIENT
4. Clinical Laboratory Services Hematology Chemistry Special Chemistry Immunohematology Serology Urinalysis Microbiology and Phlebotomy services Ability to meet patients needs Tell what services are provided through the department and what services must be provided through referral consultation contractual arrangements etc Any laboratory service not provided by LAMC Clinical Laboratory will be provided via contractual arrangements with various reference laboratories including the following services Histology Cytology and esoteric miscellaneous laboratory procedures Levels of staff by position and hour available core staffing LAMC Clinical Laboratory utilizes Regular Part time and PRN staffing to ensure adequate staffing measures are met in the following areas Outpatient FTE s 1 0 Receptionists 1 0 Customer Service Representative 6 0 Laboratory Assistants 5 5 Medical Technologist Medical Technician Weekend and off 1 5 Evening Medical Technologist shift FTE e 1 0 Night Shift Medical Technologist 1 0 Weekend Day Shift Technologist 1 0 Weekend Night Shift Technologist 0 1 Saturday Laboratory Assistant How is staffing augmented or increased when needed Staffing remains the same and occasionally overtime may be used Recognized practice standards or guidelines LAMC is accredited by the following agencies for practice standards College of American Pathologists CAP
5. Los ALAMOS MEDICAL CENTER 2010 Clinical Laboratory Services Manual 3917 West Road Los Alamos NM 87544 505 661 9542 Fax 505 662 5437 Los Alamos Medical Center Laboratory Services Manual Table of Contents Introduction Mission General Information Laboratory Contact Information Accreditations Proficiency Testing Program Organization Plan Scope of Service Local Policies Billing Information Laboratory Requisitioning and Reporting Laboratory Requisition Form Pathology Requisition Form Pathology Frozen Section Requisition Form Cytology Requisition Form PAP Smear Cytology Requisition Form Blood Bank 1 Requisition Form Blood Bank 2 Requisition Form Computer Downtime Requisition Criteria for the Acceptance Rejection of Laboratory Specimens Laboratory Critical Value Reporting Specimen Collection General Information Labeling of Laboratory Specimens Collection of Specimens for Crossmatch or Type and Screen Correct Order of Draw Venipuncture Procedure Capillary Puncture Procedure Instructions for the Collection of A Mid Stream Urine Specimen Female Clean Catch Male Clean Catch Instructions for Routine 24 hour Urine Collections Instructions for the Collection of A Stool Specimen Instructions for the Collection of A Semen Specimen o2 o0 1O0 tA RR RAR 11 12 13 14 15 16 17 18 19 21 23 24 25 26 28 29 31 33 34 35 36 37 Microbiological Specimen Collection Requirements
6. Lifepoint Corporate Policy LOCAL POLICIES Animal Specimens LAMC Laboratory does not accept animal specimens for testing except by special arrangement Cancellation of Tests Cancellations received prior to test set up preparation will be honored at no charge Requests received following test set up will not be honored A report will be issued automatically and charged appropriately Medical Legal Specimen Collection LAMC Laboratory is capable of providing medico legal specimen collections An employer account must exist and a chain of custody form must be obtained in advance No forensic testing 15 performed at this facility All forensic specimens are sent to qualified reference laboratories LAMC is not certified to perform DOT collections Radioactive Specimens Patients who are receiving any type of radioactive treatment of diagnostic test must notify the laboratory before testing is administered Failure to notify will invalidate certain testing methodology results Specimens are not routinely tested at LAMC for background radioactivity Supplies LAMC Laboratory provides at no charge materials and instructions for proper collection submission and transportation of specimens to the laboratory Supplies are available for collection and submission of specimens that are referred to LAMC Laboratory only Supply usage is monitored LAMC Laboratory customers are encouraged to inventory their supplies on a regular basis to
7. s full name date of birth date and time drawn and source e Any specimen which is obviously grossly contaminated or rancid e Any specimen collected in a non sterile container Cultures 20 e Any specimen received which is not labeled with the patient s full name date of birth date and time drawn and source e Any specimen except stool not collected aseptically e Any specimen which has not been brought to the lab immediately placed in proper transport media or refrigerated e Specimens that are grossly contaminated externally or specimens in leaky containers e Any specimen collected in a non sterile container Anatomic Pathology e Any specimen received without proper identification is to be returned immediately to the OR for correction See submission requirements e Any specimen without a brief clinical history is to be rejected Cytology e Any specimen received which is not labeled with the patient s full name date of birth date and time collected and type and source of collection e Requisition must be properly filled out e All gynecological Pap smear requests should include age last menstrual period pertinent medications and any other pertinent history including previous suggestive Pap smear results e Specimens should be in proper fixative See SOP Cytology General Information If a specimen does not meet the stated requirements it is at the discretion of the technologist performing the indicated tes
8. Collection of Specimens to be Cultured Aerobic Culture Blood Culture Cerebrospinal Fluid Other Sterile Body Fluids Sputum Specimens Urine Specimens Stool Culture Wound Culture Anaerobic Culture Nasopharyngeal Culture Ova and Parasite Collection of Specimens for Histology Collection of Cytology Specimens Body Fluids Washings Tissue scrapings Fine Needle Aspiration Sex Chromatin Determination LIS Downtime Information Test Menu Approved Panels Alphabetical Listing of Laboratory Tests Laboratory Supply Request Form 38 39 41 42 43 44 45 46 63 Introduction This Laboratory Services Manual features the procedures and services available from the clinical laboratory at the Los Alamos Medical Center It is designed to serve as a reference for the collection and submission of specimens for analysis The clinical laboratory offers a wide range of valuable diagnostic services With highly trained personnel and state of the art technology we are able to provide around the clock clinical laboratory analysis in Chemistry Hematology Immunohematology Urinalysis Microbiology and Serology For those procedures that are not performed in this facility we have acquired the services of larger and often very specialized reference laboratories that share the same beliefs as we do in providing you with high quality lab results HOSPITAL MISSION We believe the heart of healthcare is service to others Our single goal is to pro
9. avoid depletion of stock and allow LAMC Laboratory to accurately plan inventory ordering patterns Please refer to and use the inventory request form located in the back of this manual Billing Information Tests are billed separately or by panel A combination of individual tests and panel billing is possible if tests ordered are not included in a panel Fees for testing are available upon request Medicare will not pay for tests that are not considered medically necessary Laboratory personnel will determine if medical necessity criteria is met before collecting a sample from the patient non emergency cases only If the diagnosis does not support the test s ordered laboratory personnel will prepare and Advanced Beneficiary Notice ABN In non emergency situations the ABN must be signed by the patient before the sample is collected If you have any questions regarding your bill please contact the Los Alamos Medical Center Business Office at 505 662 4201 option 5 Laboratory Requisitioning and Reporting Laboratory Requisitioning and Reporting Each specimen must be accompanied by a completed requisition or doctor s order signed by the ordering physician To prevent testing delays all tests and panels ordered should be clear Laboratory personnel will clarify unclear orders before collecting or process samples All Laboratory requisitions must have the following complete information Patient s Full Name Patient s Dat
10. capped container Urine Specimens patients should void the first portion of the specimen into the toilet then secure the remainder of the specimen in a sterile container Keep urine refrigerated until sent to the lab To obtain a clean catch collection of urine please follow instruction found in Specimen Collection section of this manual For indwelling catheters obtain the specimen with a needle and syringe Stool Culture Collect stool without urine contamination Select portions of stool containing pus blood or mucous and place in stool container Transport to laboratory as soon as possible 40 Wound Culture Swab infected area place swab into transport sheath and crush capsule at bottom of sheath Transport to lab as soon as possible Anaerobic Culture Specimens collected using Culturettes and tissue samples are adequate only if transported to lab within minutes of collection Specimens from the following sites are not acceptable Throat or nasopharyngeal swabs Sputum and bronchoscopy specimens Feces and rectal swabs except for C diff cultures Voided or catheterized urines Superficial wounds Nasopharyngeal Culture Insert flexible fine shafted sterile swab into nostril to the posterior nasopharynx and gently rotate Place swab into Culturette sheath and transport to lab as soon as possible Ova and Parasite A series of three specimens within a 10 day period is usually recommended Collect stool with
11. screen Gram Stain Anaerobic 87076 Occult blood 82270 Misc Blood culture 87040 Fecal WBC S 87205 SOURCE TIME DATE COLLECTED 87118 E Sensitivity 87186 Throat full 87070 Funguscutt 87101 OTHER TESTS Please write ICD 9 code next to each test ordered Ordering Physician Written By FM5373 Rev 3 07 1 Pathology Requisition Form LOS ALAMOS MEDICAL CENTER Los Alamos New Mexico 87544 PATHOLOGY REPORT 1 Gross Only Patient 1 Gross amp Micro Tissue Submitted Clinical Data amp Pre operative Diagnosis Operative Findings Surgeon Gross Description amp Histologic Examination Pathologic Diagnosis Pathology Frozen Section Requisition Form x3 LOS ALAMOS MEDICAL CENTER LOS ALAMOS NEW MEXICO PATHOLOGY REPORT FROZEN SECTION CLINICAL DIAGNOSIS PATIENT I D SURGEON FROZEN SECTION DIAGNOSIS COMMENT _ A MALIGNANT B BENIGN U C INDETERMINATE 14 Los Alamos Medical Center Cytology Requisition Form D Los Alamos Medical Center Box 3917 Los Alamos NM 87544 Phone 505 662 4201 Toll Free in NM 1 800 541 8790 CYTOLOGY Operated by Lutheran Hospitals and Homes Society Fargo North Dakota 58102 PATIENT 1 C INPATIENT O OUTPATIENT ROOM CYTOLOGY Please Complete For All Cytology Specimens FOR CYTOLOGY RESULTS PERTINEN
12. towelettes 8 While still holding the end of the penis Remove the lid of the sterile container and place lid upside down on the clean surface 9 Grasp the cup so that fingers do not touch the inside surface 10 Begin to urinate in the toilet 11 After a few seconds of continuous urination and without stopping the flow of urine fill the collection cup about half full 12 Place the cup on a clean surface and place the lid on top of it 13 Continue to urinate into the toilet 14 Upon completion tighten the lid and place cup inside the small door next to the sink 15 Wash hands thoroughly with soap and water rinse and dry them 16 Notify lab personnel that specimen has been collected on your way out 35 gt Instructions for Routine 24 hour Urine Collections Please read carefully If you have any questions please call 661 9540 For your physician to receive accurate results on the tests that are ordered for you please completely collect all of the urine that you produce for the entire 24 hour period Drink the usual amount of liquids during the collection period unless instructed otherwise by your physician Do not drink alcoholic beverages 24 hour Urine Collection Empty your bladder and discard this urine Record time and date of step 1 Collect all urine for the next 24 hours in the container provided Bl At the same time on the second day empty your bladder and include this specimen
13. Institute API Los Alamos Medical Center Clinical Laboratory Ruth McDaniel Interim Los Alamos Medical Center CEO Clark Anderson M D Laboratory Medical Director Beverley Simpson MT ASCP Laboratory Director Joselene Montoya MT ASCP Resource Technologist Norma Buttler MT ASCP Chemistry Lead Technologist Juanito Naval Jr MT Hematology Urinalysis Lead Technologist Leo St Jean MT ASCP Safety Officer Elaine Joseph MT ASCP Ana Maria Ojeda MT Sandra Lopez Lab Assistant Monica Pacheco Lab Assistant Dawna Romero Lab Assistant Corine Torrez Lab Assistant Wendi Akerley MT ASCP Blood Bank Coagulation Lead Technologist Jana Nichols MT ASCP Microbiology Lead Technologist Laurie Veal MLT Weekend Lead Technologist Mindy Kohn MLT Lauren Williamson MT ASCP Sarah Martinez Lab Assistant Reina Coriz Lab Assistant Colleen Sandy Lab Receptionist Scope of Service Laboratory Types and ages of patients served Neonate Infant Pediatric Adolescent Adult and Geriatric Patients Hours of Service Outpatient Services Monday Friday 6 30am to 5 00pm Saturday 8am to Noon Gateway Medical Draw Station Monday Friday 6 30am to Noon Espanola Clinic Draw Station Monday Friday 6 30am to Noon Inpatient Services amp 24 hours per day 7 days per week Emergency Care Specific services provided to for and with patients and their significant others
14. N FULL NAME COMMENTS OR ADDITIONAL COPY OF REPORT TO PATIENT PHONE SOCIAL SECURITY DATE TIME COLLECTED MEAT COLLECTED COLLECTED AM PM BY WHEN MEDICARE PAYMENT WILL BE SOUGHT ONLY TESTS WHICH ARE MEDICALLY NECESSARY SHOULD BE ORDERED B RESPONSIBLE PARTY ontviF PATIENT IS MINOR LIPHP CIBCBS JUnited Health CI OTHER PLAN MEMBER NAME 1D NUMBER GROUP 5 EMPLOYER OF NUMBER PRIMARY CARDHOLDER AMA PANELS P ICD 9 ATOLO ICD 9 D 5 ICD 9 Basic Metabol 80048 GBC Diff 85025 Carbamaz 80156 Comp Metabol 80053 H amp H 85018 Digoxin 80162 Electrolytes 80051 Manual Diti 85007 Dilantin 80185 Liver Function 80076 Retic Ct 85044 Phenobarb 80184 Hepatitis Panel 80074 Sed Rate 85651 Theophyl 80198 Lipid Panel 80061 URINALYSE ICD 9 Valproic A 80164 ICD 9 Arthritis Panel 80072 UA 81000 OA ATIO o Panel 80055 Micro 81015 PT 85610 Renal Panel 80069 Clinitest 81002 PTT 85730 1 9 De AST SGOT 84450 GLU fst 82947 86900 Amylase 82150 rdm 82947 Rh 86901 ALT SGPT 84460 GlycoHgb 83036 Ab Screen 86850 __ Bilirubin total 82247 HCG quant 84702 Bilirubin direct 82247 HCG qual 84703 ROLO ICD 9 Cholesterol 82465 84132 Mono spot 86308 HDL Cholest 83718 PSA 84153 RA 86430 GGT 82977 TSH 84443 RPR 86592 MICROBIOLOGY M _ Rapid Strep 87430 Giardia Ag Culture routine 87070 Strep
15. T CLINICAL INFORMATION OR INFORMATION PREV MALIGNANCY DATE TYPE PREV CONCURRENT BIOPSY DATE TIME CALL 662 4476 O TREATMENT DATE TYPE LEVEL OF SUSPICION FOR MALIGNANCY CALL 820 5921 FOR THIS SPECIMEN HIGH LOW Gynecological Non Gynecological PAP SMEAR Of Slides ASPIRATIONS RESPIRATORY 7 O Cyst O Solid Size O Sputum Induced Site D Vagina Cervix SITES O Bronchoscopy Site DEndocer O Other OBreast ORL OL O Bronch Wash LMP O Lung Site O Bronch Brush D IUP O Lymph Node O BAL O Post Partum Lactating Site A A AAA s O Pneumocystis INDUCED SPUTUM OR O Hormonal Contraceptives O Pelvic Mass f BRONCH WASH ONLY O IUD Site _ BODY FLUIDS EFFUSIONS O Hormone Therapy O Salivary Gland O Pericardial Fluid Type Site O Peritoneal Fluid O Hysterectomy El Other OPleural OR Olt Reason MG mr SF cerebrospinal fluid PREV SMEARS Date MISCELLANEOUS OG Tract O Normal O Nipple Discharge OL Site O Abnormal Type OfSlides_ O Other O Other Site Site Urolagic Specimens EI Thyroid Specimens URINE OVoided Cath O RENAL PELVIS URETER Ort BLADDER WASHING O Thyroid O Rt O Lt Thyroid Function Tests Hyperthyroid Radioisotope Scan Resulis 1 1 1 1 Antibody Status i e Antimicrosomal Antibodies Antithyroglobulin Antibodies Ol Euthyroid Yes No Yes No Irritative Voiding Symptoms O Cystoscopy Abnormal Li Li Previo
16. ate sharps containers and biohazardous waste containers 24 Process specimens appropriately for the tests ordered 25 Wash hands tourniquet or use appropriate disinfectant after each use Procedure notes Application of tourniquet for longer than 1 minute may cause hemoconcentration or hemolysis which may result in variation of test values e Capillary Puncture Procedure 1 Verify that the tests ordered on the requisition match the tests on the collection labels 2 Identify the Patient 3 Position the patient so that he she is comfortable but also so the capillary puncture site is accessible 4 Select the appropriate incision site THEN IF Use the middle or ring finger e Performing a finger stick See Figure 1 e Select an area at least 2mm e Performing a heel stick away from previous wounds and avoid edematous areas See Figure 2 5 Clean the incision area with an alcohol wipe and allow to air dry or dry with sterile gauze 6 Remove the safety clip from the tenderfoot device ds Place the blade slot surface of the device flush against the heel or finger 8 Depress the trigger 9 Immediately remove the device from the skin 10 Wipe away the first drop of blood with a sterile gauze pad 11 Fill the appropriate microtainers taking care not to make direct wound contact 12 When collection is complete apply gentle pressure to the wound with a ste
17. beled specimen tubes 26 Collection of Specimens for Crossmatch or Type and Screen Purpose This procedure provides instructions for the collection of specimens that will be used in the transfusion service Critical to the safe practice of transfusion medicine is the collection of a properly labeled blood sample from a correctly identified patient for pretransfusion testing The phlebotomist who collects the blood sample must positively identify the patient correctly complete the armband and properly label the tubes Policy Specimens not collected and labeled properly will be rejected Blood Bank specimens used for transfusion must be collected by hospital personnel Specimen Collection Handling Storage e 6 mls of whole blood in an EDTA lavender top specimen is preferred a 7ml plain red top is acceptable e Whenever a new specimen is drawn a new Typenex Blood Bank band must be used and the old one must be removed by the phlebotomist e Time of Specimen Collection e When a patient has been transfused or pregnant within the last 3 months or when such information is unavailable or questionable a sample of the patient s blood must be obtained within 72 hours of the scheduled transfusion e For patients that have not been transfused or the patient is only being given platelets the specimen may be collected up to 5 days prior to transfusion However the ABO Rh type and antibody screen must be performed within 48 hours of coll
18. e of Birth Signature of Health Care Provider Initials of person preparing the requisition Diagnosis or ICD 9 code List of tests requested Additionally patient s gender and source of specimen when applicable are helpful in proper analysis and interpretation There are four different levels in which to prioritize result reporting Each report will contain the specific result and normal range if established These four levels are as follows e ROUTINE Regular specimen processing and analysis performed on a daily or batched basis Results available next business day or sooner e ASAP AS SOON AS POSSIBLE ASAP gives a higher priority than routine Results available within 2 hours of receipt e STAT Highest priority To be used only for life threatening situations Results available within 1 hour of receipt e TIMED Utilized for those tests e g glucose drug level or Troponin I which require collection and testing at specific intervals Result turnaround times may vary usually within hour of receipt The following requisition forms should be used when requesting laboratory tests They are available from the lab during normal business hours 11 General Laboratory Requisition Form Los ALAMOS DN MEDICAL CENTER MEDICAL RECORD PATIENT INFORMATION PERSON RESPONSIBLE FOR BILL PATIENT INFORMATION SCREENED AREAS MUST BE FILLED IN MI PATIENT ID DATE OF BIRTH SEX FASTING i M YES NO ORDERING PHYSICIA
19. e patient Patient must be banded at the time the blood is drawn e Any specimen which is obviously contaminated or rancid e Specimens more than 1 hour old for acetone or ammonia determinations e Blood for alcohol determination collected with an alcohol wipe preparation of the venipuncture site e Specimens for which fasting specimens are required that are known to have been collected in a non fasting state See individual procedures e Specimens for which timed collection is critical that are not collected at the proper time These include glucose tolerance lactose tolerance drug levels and Troponin I e Specimens of insufficient quantity Some exceptions will occur Sample should not be discarded even though quantity is not sufficient e Hemolized specimens will invalidate many chemistry tests Hemolysis should be avoided whenever possible e Any specimen received which is not labeled with the patient s full name date of birth and date and time drawn e Any specimen collected in a non sterile container e Urine unrefrigerated for more that 2 hours will be rejected e Any specimen which is obviously cloudy and characterized by extremely rancid smell indicating bacteria multiplication in vitro e Urines known not to be collected at the proper time for those procedures requiring special timed voiding See individual test procedure e Leaking containers Body Fluids e Any specimen received which is not labeled with the patient
20. ection Equipment Supplies Blood Bank I requisition Blood Bank II requisition Typenex Blood Bank Band Phlebotomy Supplies Special safety precautions Universal precautions should be followed at all times 297 Procedure Verify the requisition is filled out properly and includes the following information e Patient s full name spelled correctly Patient s Medical Record number Patient s Date of Birth Location of patient Tests ordered including the number of units needed Date units to be transfused if known Physician ordering the test Status of test Emergency Pre op ASAP etc e Diagnosis Identify the patient See procedure PHLO1v1 Identifying Patients for Specimen Collection If the patient is an outpatient they must read and sign an instruction form outlining the purpose and care of the Typenex Blood Bank Band Fill out the Typenex band using the information on the hospital ID bracelet and the patient The band should have the following information e Patient s full name spelled correctly e Date of Birth e Medical Record number e Date and time of draw e Collector s initials Draw a plain red top and a lavender top tube See SOP Collection of a Blood Specimen by Venipuncture Remove the self stick label from the Typenex Band and use it to label the red top tube Place the Typenex band on the patient s wrist remove the series of ID numbers on the band after it has been seal
21. ed Write the date and time of collection and the collector s initials on the Blood Bank I requisition 9 Place ID sticker from the band on the Blue Copy of the Blood Bank I requisition 10 Deliver the specimen and all paperwork to the Laboratory Procedure notes e When a patient has been transfused or pregnant within the last 3 months or when such information is unavailable or questionable a sample of the patient s blood must be obtained within 72 hours of the scheduled transfusion e All inpatient requests and ER patients that have the potential of being transfused should be received on a Blood Bank I requisition form Correct order of Draw 28 In order to prevent contamination and ensure accurate laboratory results specimens must be drawn in the proper order Blood Culture ALWAYS drawn prior to other labs to reduce contamination Special Bottles Sterile Procedure is Necessary Light Blue 3 2 Sodium PT PTT Fibrinogen Factor Citrate Activity Gold Top Contains clot Chemistry PSA TIBC activator and gel Di o igoxin Lithium separation Red Top No Additive Most send out tests Call lab to verify correct tube Green Top Sodium or Lithium Carbon Monoxide Heparin Do NOT use for Lithium Levels or Lavender Top EDTA Blood Bank Specimens anticoagulant 6 mL tube CBC Retic ESR A1C BNP D dimer 4 mL tube Grey To
22. en BUN Glucose Comprehensive Metabolic Panel 80053 CMP Carbon Dioxide Sodium Urea Nitrogen BUN Alkaline Phosphatase AST SGOT Lipid Panel 80061 Hepatic Function Panel 80076 LFT Cholesterol Albumin Bilirubin Total Total Protein Obstetric Panel 80055 RBC Antibody Screen Hemogram HBsAG Acute Hepatitis Panel 80074 HBsAg Renal Function Panel 80069 RFP Hepatitis C Ab Albumin Chloride Phosphorous Urea Nitrogen BUN Arthritis Panel 80072 Uric Acid Sedimentation Rate Potassium Creatinine Glucose Bilirubin Total ALT SGPT HDL Alkaline Phosphatase ALT SGPT Rubella Antibody ABO Typing HBcAb IgM Hepatitis A Ab IgM Calcium Creatinine Potassium ANA RA Factor 46 Chloride Calcium Chloride Calcium Albumin Protein Total Triglycerides Bilirubin Direct AST SGOT RPR Rh Typing Carbon Dioxide Glucose Sodium Thank you for reviewing our manual Please contact us if we can further serve you 47
23. enobarbital 40 ug ml Phenytoin 20 ug ml Salicylate 300 mg L Theophylline 20 ug ml Valproic Acid 150 ug ml Vancomycin 20 ug ml Urinalysis Department Test Values Values less than greater than Ketones Positive Newborn only Glucose or Clinitest Positive Newborn only RBC Cast Any seen 22 Hematology Coagulation Department Values Values less than greater than Hemoglobin 6 0 g dL 21 0 g dL Platelets 25 995 WBC ANC lt 500 50 000 Protime 38 9 sec PTT 100 sec Fibrinogen 100 mg dL Microbiology Department Positive Gram Stains on Spinal Fluid Positive Blood Cultures Oxacillin Resistant Staph MRSA Positive CSF Cultures Vancomycin Resistant Enterococcus VRE Positive C difficile toxin All State of NM reporting Requirements Transfusion Services Department Positive DATs Positive Antibody Screens 208 Specimen Collection Instructions Specimen Collection Instructions to patient specimen collection are available in this section of the manual Please photocopy and distribute as needed General Information e The value of any laboratory report is directly related to the quality of the specimen which is analyzed e In order to ensure the collection of a quality specimen follow collection and labeling instructions carefully and transport specimens to the laboratory as instructed in this manual e The alphabetical test listing contains the ap
24. eted test requisition must accompany all samples Information regarding the patient the specimen collection time and date clinical history symptoms and diagnosis anti microbial therapy and any suspected organism s is essential for the optimal and appropriate processing of the specimen SPECIMEN COLLECTION FUNDAMENTALS The proper collection of a specimen for culture is the most important step in the recovery of pathogenic organisms responsible for infectious disease A poorly collect specimen may lead to failure to isolate the causative organism s and result in the recovery and subsequent treatment of contamination organisms 1 2 gv Collect the specimen from the actual site of infection avoiding contamination from adjacent tissues or secretions Collect the specimen at optimal times for example early morning sputum for AFB culture Collect a sufficient quantity of material Use appropriate collection devices sterile leak proof specimen container Use appropriate transport media Whenever possible collect specimens prior to administration of antibiotics Properly label the specimen and complete the requisition slip Minimize transport time Maintain an appropriate environment between collection time and delivery to lab Contact lab for instructions if there will be a significant delay in transport If appropriate decontaminate the skin surface Use 70 95 alcohol and 1 2 tincture of iodine the site Allow a contact t
25. ime of two minutes to maximize the antiseptic effect 39 Specific Guidelines for Specimen Collection Aerobic Culture Specimen collection from normally sterile sites requires a needle puncture or surgical procedure Decontamination of the skin must be performed prior to the collection of specimens such as blood cerebrospinal fluid and other normally sterile body fluids Blood Culture Specimens for blood cultures must be submitted in blood culture bottles Decontaminate the diaphragm tops of two bottles by swabbing with alcohol or iodine after removing the protective plastic covering Fill bottles with approximately 6 8 ml of blood into each of the two bottles Swirl bottles gently to mix Keep at room temperature 15 30 C until sent to laboratory Cerebrospinal Fluid Submit a separate sterile screw capped tube containing at least 0 75mL of cerebrospinal fluid For microbiological analysis it is best to submit the second or third tube drawn Other Sterile Body Fluids Follow standard procedures and obtain the specimen by aspiration If a cell count and chemistries are desired inject 2mL of fluid into a lavender top and solid red top tube by switching out the collection needle Sputum Specimens Early morning sputum collection is recommended Patient should gargle with water prior to collection The most suitable specimen is the expectoration obtained after a deep cough Collect specimen in a leak proof sterile screw
26. in the collection 5 During collection process container should refrigerated or stored in a bucket of ice 6 Label the container with your name date of birth date and time collection was started and the date and time of completion 7 Deliver specimen along with the laboratory requisition to the laboratory as soon as possible If you forget to save some of the specimens during the 24 hour period you should discard the specimens that you have saved and start over on the following day 36 Instructions for the collection of a Stool Specimen Do not dip stool specimen from the toilet Collect specimen as described below When you return to the lab to deliver the specimen do not forget your laboratory requisition If you have any questions please call 661 9540 for assistance For Stool Culture OVA and Parasites Clostridium Difficile Stool specimen should be collected early in the illness and prior to antibiotic therapy Collect specimen in a clean container with a tight fitting lid Specimen should be free of contaminants such as urine or water Label container with patient name date of birth date and time of collection and name of ordering physician deliver to the laboratory within one hour of collection For Occult Blood Hemoccult or seracult slide Go on a red meat free diet for three days and stay on the diet until all specimens are collected Collect three different stool specimens Specimen
27. nd sign the separate ADVANCED BENEFICIARY NOTICE ABN for services that may not meet Medicare s medical necessity or frequency limitation criteria CYTOLOGY GYN SOURCE DIAGNOSIS CODES L1 Vaginal LlEndocervical 36268 Abnormal bleeding 0 795 00 Abnormal glandular Pap smear PAP TEST REQUESTED Check one of cervix LI ThinPrep Pap Test LConventional Smear Y 795 01 ASC US cervix ODNA wiPap HR 0 795 02 ASC H cervix HPV amp ThinPrep Pap for women age 30 and over El 622 11 Cervical dysplasia CIN I MOLECULAR TEST Check all that apply O 795 05 Cervical high risk HPV O HPV High Risk Reflex if ASC US DNA positive HPV High Risk Reflex fASC US and above O 616 0 Cervicitis and endocervicitis O HPV High Risk Profile O 617 0 DO HPV High Low Risk Profile HPV High Risk Profile OnlylNo Pap Test H 626 2 Excessive or frequent menstruation D HPV High Low Risk Profile Only No Pap Test L1 795 04 HGSIL cervix OCT NG O V15 89 High risk screening D CT NG Only No Pap Test 0 795 03 LGSIL cervix CLINICAL INFORMATION O 627 3 Postmenopausal atrophic vaginitis POST OPERATIVE DIAGNOSIS gt LMP Menopause date Endometriosis of uterus PRE OPERATIVE DIAGNOSIS 627 1 Postmenopausal bleeding a Last Pap Test date ___________ O V72 31 Routine gynecological examination CLINICAL HISTORY m TI History of abnormal Pap date O V76 2 Routine cervical Pap
28. on the clean surface 10 Grasp the cup so that fingers do not touch the inside surface 11 Begin to urinate in the toilet 12 After a few seconds of continuous urination and without stopping the flow of urine fill the collection cup about half full 13 Place the on a clean surface and place the lid on top of it 14 Continue to urinate into the toilet 15 Upon completion tighten the lid and place cup inside the small door next to the sink 16 Wash hands thoroughly with soap and water rinse and dry them 17 Notify lab personnel that specimen has been collected on your way out S4 Instructions for collection of Mid stream Urine specimen If you have any questions please call 661 9540 Male Patients Clean Catch I Wash hands thoroughly with soap and water rinse and dry them Remove the towelettes from the package and place them on a clean surface 5 Loosen the lid of the sterile container place the container on a clean surface 4 If you are not circumcised the fore skin on the penis must be pulled back completely If you are circumcised begin the cleansing procedure 5 Grasp the penis near the end with one hand 6 With your other hand wash the area around the urinary opening with one of the towelettes Beginning at the center of the opening wash the area around the opening using a circular motion 7 Repeat the previous step with remaining
29. out urine contamination Transport to lab immediately specimen must be placed into preservative within one hour of collection 41 Collection of Histology Specimens specimens must be accompanied by proper identification and appropriately labeled request form They will not be accepted if they are not properly labeled and the request form not completely filled out Procedure 1 All specimens should be placed in 10 formalin unless requiring fresh frozen processing 2 All requisitions should contain diagnosis or suspected diagnosis according to the clinical judgment of the surgeon 3 Specimen should not be fragmented dissected opened etc prior to submission to the laboratory 4 If margins are important they should be clearly identified either personally by the surgeon or by marking in some manner i e a stitch India ink etc 5 Material submitted for culture must be collected in a sterile manner consistent with standard microbiological technique Fresh Frozen Sections All fresh frozen sections are to be scheduled with the pathologist as far in advance as feasible If an unexpected section is needed the laboratory should be notified as soon as the potential is recognized The pathologist must be notified by telephone or pager immediately Note DO NOT leave fresh tissue unattended without notifying someone in the laboratory 42 Collection of Cytology Specimens All specimens must be accompanied by
30. p Sodium Fluoride Stat Glucose Potassium Oxalate actic Acid Level MUST be put on ice Royal Blue Special glass and Trace Elements special stopper material Toxicology testing 29 Collection Instructions Venipuncture Procedure 1 Verify that the tests ordered on the requisition match the tests ordered on the collection labels and initial requisition 2 Identify the patient Two Patient Identifiers must be used 3 Ask the patient 1f they are currently on anticoagulant therapy including aspirin If yes maintain pressure post venipuncture until bleeding has ceased 4 Position the patient so that he she is comfortable but also so the venipuncture site is accessible de Assemble necessary equipment and select appropriate tubes for the tests ordered 6 Explain procedure to the patient and family members if applicable d Select venipuncture site 8 Tie tourniquet 2 inches proximal to the area chosen for venipuncture Tourniquet should be applied with enough tension to compress the vein but not the artery If tourniquet fails to dilate vein have patient open and close fist repeatedly and maintain a closed fist during venipuncture releasing after successful insertion of the needle 9 Put on gloves and palpate the vein 10 Cleanse the site with an alcohol wipe in a circular motion beginning with the venipuncture site and spiraling outward
31. proper identification and appropriately labeled request form They will not be accepted if they are not completed and identified properly This policy is necessary for protection of the patient Procedure Body Fluid Washings All body fluid specimens should be delivered to the lab for processing within 20 minutes of collection It is essential that all fluids submitted are placed in Cytolyte preservative within 20 minutes to ensure preservation of all cell lines Cytolyte preservative 1s available in the histology section of the laboratory Contact laboratory for voided urine cytology specimen instructions Tissue Scrapings All tissue scrapings Pap Smear Secretions etc must be collected by qualified personnel Collect from the specific site Spread evenly on a labeled frosted end glass slide Fix immediately with spray fixative Allow to dry before packaging for delivery to lab Fine Needle Aspiration Notify the pathologist of the scheduled procedure as soon as possible Specimen is normally obtained in the Radiology Department or in the surgeon s office addu LIS Downtime procedure In the event of computer downtime the individual sections of the laboratory will continue to function maintaining complete information about each specimen tested for patient reporting and later input into the computer system PROCEDURE A EMERGENCIES 1 In the event of electrical power outage a The system administrator should be no
32. propriate specimen containers for each test performed in this facility and for the most commonly requested sent out tests If the test that is requested is not contained in this listing or if there is any question regarding the type of specimen that should be collected please contact the laboratory for appropriate collection instructions 25 Labeling of Specimens 1 Properly identify the patient Collect specimen 3 While still in the patient s presence label the specimen with the following information e Patient s full name e Date of Birth e Date and time of specimen collection e Initials of the person collection the specimen e Hospital number if available If available bar coded collection labels are acceptable for all non transfusion service testing however collector s initials should be on the label 4 Specimens for Transfusion service testing must be labeled with the above information using a Blood Bank Typenex Band di Deliver the specimen to the laboratory as soon as possible Procedure notes e If the specimen does not meet the labeling requirements it is at the discretion of the technologist performing the indicated test as to whether the specimen will be accepted or rejected e If the integrity of the specimen is suspect in any way the specimen will be rejected e Any mislabeled or incorrectly labeled transfusion service specimens will be rejected Examples of properly la
33. rile gauze pad until bleeding has ceased 13 Apply bandage 14 Label specimens appropriately 15 Discard any used materials properly utilizing appropriate sharps containers and biohazardous waste containers 16 Process specimens appropriately for the tests ordered Procedure notes e When performing a heel stick on an infant it may help to warm the heel prior to incision Place the heel in a diaper that has been saturated with warm water for 5min prior to performing the heel stick 90 Figure 1 Finger stick site Figure 2 Heal Stick or Toe Stick 33 Instructions for collection of Mid stream Urine specimen If you have any questions please call 661 9540 Female Patients Clean Catch 1 Remove undergarments 2 Wash hands thoroughly with soap and water rinse and dry them 3 Remove the towelettes from the package and place them on a clean surface 4 Loosen the lid of the sterile container place the container on a clean surface 5 While sitting on the toilet with legs spread apart spread the skin around the urinary opening Keep skin spread until collection is complete 6 With one stroke from front to back wash the skin on one side of the urinary opening using one of the towelettes T Repeat step 6 for the other side 8 Using another towelette wash the center from front to back 9 Remove the lid of the sterile container and place lid upside down
34. s This list is not all inclusive if you do not find what you are looking for please contact the laboratory for specimen collection and transport information Testing Priority As Ordered Send Out Batched Testing will be performed as it is ordered Results available next business day or sooner Testing not performed on site specimens sent to reference lab Results available in 3 to 5 business days for most tests Testing performed once per day M F Abbreviations used in the Testing List Specimen Type S WB P U F Stool Wash Sputum NP Draw Tube R 1 GS LB BC GR U BG GY V S Serum Whole Blood Plasma Urine Fluid Fecal Material Bronchial Wash Sputum Nasopharygeal Swab Red stopper No Additive tube Lavender stopper EDTA anticoagulant Gold stopper serum separator tube Light Blue stopper Sodium Citrate anticoagulant Blood Culture Bottle Green stopper sodium or lithium heparin anticoagulant 24 hour Urine Collection Container Blood Gas Syringe Gray stopper Sodium Fluoride Potassium Oxalate anticoagulant Viral Culture Media Sterile tube with 1 mL saline 45 Listing of HCFA AMA Approved Organ and Disease Panels These are the only panels offered by Los Alamos Medical Center Laboratory Electrolyte Panel 80051 Carbon Dioxide Potassium Chloride Sodium Basic Metabolic Panel 80048 BMP Carbon Dioxide Potassium Sodium Creatinine Urea Nitrog
35. s can be collected in a clean disposable container such as a margarine tub or Cool Whip container Each time you collect a specimen open tab on card use a tongue depressor to take a very small amount of stool specimen and apply thin smear of specimen in the two areas as instructed close cover Label each card with patient name and date and time of collection Store at room temperature The patient may wait and bring all cards to the laboratory at one time Instructions for the collection of a Semen Specimen 1 A period of 2 3 days of abstinence no intercourse or masturbation will provide the most accurate assessment prior frequent ejaculation may reduce the sperm count and volume However there should be no more than 7 days of abstinence 2 Please collect your specimen between 7am and 2pm Monday thru Friday It is important that we begin the analysis within one hour of collection so please deliver the specimen to the lab immediately The sample should be protected from extreme heat or cold during transport 3 Your physician will provide you with a clean wide mouth plastic container or you may also get one from the laboratory Collect the specimen directly into the container NOTE The specimen should not be collected in a condom because some prophylactics contain spermicidal agents and may kill the sperm 4 The sample must be obtained by Masturbation after the appropriate period of abstinence Masturbation is preferred to in
36. t as to whether the specimen will be accepted or rejected If the integrity of a specimen is suspect in any way it will be rejected Any mislabeled or incorrectly labeled transfusion service specimens will be rejected When a specimen is unacceptable for testing the office of the ordering physician will be notified and the patient will be contacted 2291 Laboratory Critical Values All critical values must be verified by repeat analysis and called to the doctor If the doctor cannot be reached the physician on call or the designated nurse should be notified Documentation of the time and person to whom the result was reported to must be made on the patient s HMS report along with the technologist s initials and verification of read back Chemistry Department Test Values Values ENG EN less than greater than Sodium 125 mEq L 155 mEq L Potassium 3 5 MEQ L 6 0 mEq L Calcium 7 0 mg dL 11 5 mg dL Renal Patients lt 5 0mg dL Glucose 50 mg dL 400 mg dL Amylase 1500 U L Creatinine 6 0 mg dL Neobilirubin 15 0 mg dL pH 7 15 7 55 2 10 mmHg 60 mmHG HCO3 10 mEq L 45 mEq L 24 hour Urine Total Protein 300mg 24hr Pregnant Women only Troponin 2 0 ng mL Acetaminophen 4 hours post ingestion 150 ug ml Acetaminophen 12hrs post ingestion 50 ug ml Carbamazepine 10 ug ml Digoxin 2 0 ug ml Gentamicin peak 10 ug ml Gentamicin trough 2 0 ug ml Lithium 2 0 mEq L Ph
37. terrupted intercourse because the later may result in loss of a portion of the ejaculate Avoid using lubricants 5 the specimen should be clearly marked with your name and date of birth In addition please provide the following information Name Date Collection Time Days of Abstinence Collected by Masturbation circle one YES NO Transportation Problems circle one YES NO Post Vasectomy Check circle one YES NO 6 If any portion of the ejaculate is not collected or if the container leaks during transport the specimen should be recollected The lab will notify your physician of the results The result will be discussed with you at your next visit to your doctor s office 38 Microbiological Specimen Collection Requirements Collection of Specimens to be cultured e Whenever possible specimens should be obtained before antimicrobial agents have been administered e Request forms accompanying specimens to be tested for antibiotic activity should contain the name s of the antibiotic s being administered Labeling Microbiology specimens are not acceptable unless each specimen is appropriately labeled The specimen must be identified by the patient name date of birth collection date and source of specimen Slides must also be labeled with patient name date of birth and collection date Placing an unlabeled specimen into a container and then labeling the outer container is not acceptable Requisitions A compl
38. tified immediately b All terminals and printers should remain powered on supported by the Hospital s Auxiliary Emergency Generator B SPECIMEN PROCUREMENT 1 The lab assistants technologists or nursing services personnel will collect and deliver specimens utilizing the Lab Computer Downtime Requisition form Refer to page 18 for requisition form 2 Each Requisition will contain the following information Patient label if available or Patient s name Medical Record and Account Specific tests to be performed Priority STAT ASAP Timed or Routine Ordering practitioner Collector s initials Collection date and time SES C LABORATORY DEPARTMENT PROCESSING AND REPORTING 1 All specimens coming into the department must be accompanied by a downtime request slip This slip will accompany the specimen to each department of the Laboratory for testing 2 Specimens with previously printed HMS labels will have the label placed on the specimens for tracking purposes 3 Any specimen comments should be noted on the request slip 4 Once testing is completed utilize the Manual Report Forms see attached to copy the analyzer results to which will be used for distribution to the ordering department or clinic 44 Test Menu The following table is a list of tests available through the Los Alamos Medical Center Laboratory The list includes all tests currently performed on site and many of the more common send out test
39. to cover and area approximately 2 inches in diameter Allow alcohol to dry Do not touch the cleansed area with an unclean finger 11 Immobilize the vein by pressing just below the venipuncture site with your thumb and draw the skin taunt Gloves on 12 Position the needle holder or syringe with the needle bevel up and the shaft parallel to the path of the vein and at a 15 30 degree angle to the arm 13 Insert the needle into the vein 14 If using a syringe withdraw the blood slowly by gently pulling back the plunger of the syringe If using evacuated tubes with a needle holder grasp the holder firmly and push down on the collection tube until blood flows into the tube automatically 15 Release tourniquet as soon as a steady flow of blood is noted and have patient relax their fist 16 Continue to fill the required tubes in the appropriate order 17 Gently rotate each tube 5 10 times as you remove it to help mix the additive 18 Place a cotton ball or gauze pad above the venipuncture site 19 Apply slight pressure to cotton ball and remove the needle slowly and smoothly 30 20 Continue to apply firm pressure to the site or ask the patient to do so 1f they are able until the bleeding subsides If patient is on anticoagulant therapy maintain pressure longer 21 Bandage the area 22 Label the tubes at the patient s side 23 Discard any used materials properly utilizing appropri
40. us Tumor O Papillary Lesions Seen O O Thyroid Mass OsSolid O Cystic Recent Chemotherapy A Biopsy Taken it cystic does it disappear post aspiration DYes Radiation Therapy O Microhematuria O History of previous neck radiation LiYes ONo Previous Urologic Surgery O Ileal Conduit present O Family history of thyroid disease LiYes Nephrolithiasis o O Level of suspicion for malignancy OHigh O Low PLEASE DO NOT WRITE BELOW THIS LINE Cytologic Diagnosis CYTOTECHNOLOGIST DATE PATHOLOGIST DATE PAP Smear Cytology Requisition 15 res S MEDICAL Pathology Consultants of New Mexico 3917 WESTRD The Right Path LOS ALAMOS NM 87544 gt 600 N Richardson PO Box 2208 Roswell NM 88202 accout Number 0001798 5056619540 575 622 5600 800 753 7284 Fax 575 622 3720 Www pchin com ae ode 302047 LL ing Clinician Si 2047 302047 1 HE FABLE gt 1 1 302047 ORIGINALTO COPY FOR THE PATIENT S CHART NE SE PATIENT INFORMATION INSURANCE COMPLETE OR ATTACH COPIES OF FACE SHEET OR INSURANCE CARD S FR PCNM files ALL amp PRIMARY INSURANCE INFORMATION Insurances Required MEDICARE MEDICAID BCBS HEALTHSMART LOVELACE COMMERCIAL Subseriber s Employer SECONDARY INSURANCE INFORMATION Required Insurance Company Address Name ID Group Insurance Company Address X Medicare patients must review a
41. vide affordable accessible first rate healthcare that improves the health and well being of the people we serve and raises the quality of life for all concerned Working in partnership with communities we constantly seek to build healthcare systems that are locally focused and nationally recognized as the standard by which community hospitals are judged LABORATOTY MISSION We will provide high quality cost effective laboratory analysis to health care providers in Los Alamos County and Northern New Mexico General Information Address Los Alamos Medical Center Laboratory 3917 West Rd Los Alamos New Mexico 87544 Phone Numbers Main Laboratory Direct Line 505 661 9542 Laboratory Director 505 661 9126 Laboratory Fax 505 662 5437 Gateway Collection site 505 662 0442 Gateway Collection Fax 505 662 0464 Espanola Clinic 505 662 2177 The following extensions are valid only within the hospital Blood Bank ext 1543 Chemistry ext 1547 Hematology ext 1549 Microbiology ext 1546 Pathology Cytology results ext 1518 Laboratory Results ext 1542 Blood Collection Requests ext 1542 or 1540 Laboratory Director ext 1126 Accreditations College of American Pathologists CAP 22396 01 Clinical Laboratory Improvement Amendments CLIA of 1998 32D0536733 Joint Commission on Accreditation of Health Care Organizations JCAHO 2009 Proficiency Testing Program College of American Pathologists CAP American Proficiency
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