S p e c i m e n S u b m i s s i o n P o l i c i e s & P r o c e d u r e s
Label all specimens submitted for testing with the patient's complete name or identifying number as written on the Test Request Form (PDF). This will assure positive identification and optimum integrity of patient specimens from the time of collection until testing has been completed and results reported. Clients will be notified of inappropriately labeled specimens and the specimen will be returned to the client. Tests will not be unlabeled or incompletely labeled specimens.
Specimen Rejection
Criteria
Specimens will be rejected and the tests and charges canceled under the following conditions:
- Unlabeled or incompletely labeled specimens
- Name on specimen does not match name on requisition or electronic order
- Leaking specimen
- Broken container
- Incorrect specimen submitted for test requested
- Insufficient volume (QNS)
- Improper specimen transport temperature
- Age of the specimen (test dependent)
- Hemolysis (test dependent)
- Specimens received with no written or electronic order
Referral Testing Policy
Cleveland Clinic Reference Laboratory serves its clients by selecting and using qualified, licensed reference laboratories to perform those tests not available at the
Cleveland Clinic. Laboratories are identified based on the quality of service provided. Such services include, but are not limited to, accuracy, reliability, turnaround time,
customer service, ease of reporting and range of services offered. Clients may, for medical reasons, request that a test be referred to a specific laboratory other than the Cleveland Clinic or one which is routinely utilized by
the Cleveland Clinic Reference Laboratory. Following consultation with the client regarding such requests,
the Cleveland Clinic Reference Laboratory will honor the client's request and forward
the specimen. A service fee of $30 will be charged in addition to the routine handling fee and the cost of the test.
Unacceptable Specimen Containers
- Needles: In response to OSHA standards and good laboratory practices, the laboratory will not accept, transport or test any specimen contained in a syringe with a needle attached.
- Glass tubes: The use of glass tubes, especially frozen specimens, should be avoided due to the increased risk of broken glass and biological contamination.
Acceptable transport tubes are available upon request from the
Reference Laboratory (contact Client
Services).
Specimen Handling and Transport
- Complete a Test
Request Form (PDF)
for each patient using a black ballpoint pen. Please print. Record all required patient information.
- Patient name, sex, birth date, social security number and medical record or lab reference number.
- Collection date and time.
- Type of specimen submitted
- Condition of specimen (frozen, refrigerated, room temperature).
- Patient fasting conditions.
- Total volume if 24-hour urine.
- Source of specimen if for microbiology or virology test(s).
- Presumptive clinical diagnosis and any pertinent medical history (onset of illness, recent vaccinations, etc.).
- Complete billing information (patient address and all insurance information) if patient or insurance is to be billed.
- ICD-9 Code for each test.
- Mark box(es) [x] indicating the test(s) requested. For tests not pre-printed on the test request form, clearly print the name and order code for each additional test (see Test Directory) on the bottom of the form.
- Keep bottom copy of form for your records.
- Write patient name legibly on specimen containers with a ballpoint pen. Be sure that name or identifier written on specimen exactly matches name on test request form. Provide patient's social security number on tube for Blood Bank tests. Unlabeled specimens will be rejected.
- Fold completed form in half with patient information facing-out.
- Place labeled specimen(s) in the sealed portion of specimen bag. Place the folded test request form into the outer portion of specimen bag.
- On outside of specimen bag mark the box corresponding to correct temperature at which specimen is to be maintained during transport.
Note: If submitting more than one specimen per patient, and specimens need to be stored and transported at different temperatures, use separate bags and separate test request forms for each temperature type.
Frozen Specimens: Serum or plasma specimens need to be frozen only if specifically stated in the specimen requirement. In these cases, it is essential to freeze the specimen as soon as it is
separated from the cells. Always freeze specimens in plastic tubes unless specifically instructed otherwise. Glass tubes are not acceptable. Lay the tube in the freezer at a
45º angle to avoid tube breakage caused by expansion during freezing. Apply labels to the tube with ends overlapping to prevent detachment of label from tube during freezing.
Submit a separate specimen for each test that must be frozen. Thawed samples are not acceptable for analysis. Indicate if the specimen is plasma or serum on both the
specimen and the test request form.
Specimen Storage: Instructions for storage and shipment of specimens for individual tests are listed under specimen requirements in the
Test Directory. Maintain the specimen at the
temperature indicated for each test until specimens are delivered to the laboratory . Most specimens require refrigeration unless
otherwise indicated.
Packing Procedures for
Commercial Carrier Shipment
When preparing specimens for shipment via overnight carriers, follow the instructions below.
- Pack as many as 12 specimen bags of the same temperature type in one 10" x 12" Ziplock bag.
- Package the bags of refrigerated specimens in an insulated container with a minimum of two cold gel packs. Do not allow cold packs to come in direct contact with glass tubes.
- Package frozen specimens in insulated containers available from the laboratory. Surround the specimens with dry ice. Thawed specimens are unsuitable for analysis.
- Pack room temperature specimens in an insulated container. Do not use any cold packs with such specimens.
- Packing should always be done in a manner which assures that 5 (five) pounds of dry ice (if specimens are frozen), or two cold gel packs (if specimens are refrigerated), can be placed in the container with Ziplock bags.
- Do not mix specimens with different temperature requirements (for storage and transport) in the same shipping containers.
Note: Specimens submitted by mail should comply with all Federal packaging requirements, including Postal Service, U.S. Public health Service, and the Latest Federal biohazard regulations. (See Department of Transportation Regulations 49 CFR 173.) As a general rule, packages should not exceed 5 pounds.
Lead and Heavy Metal
Testing
State Departments of Health mandate testing laboratories to report specific patient demographics as well as results directly to the State.
Cleveland Clinic Reference Laboratory conforms with all such requirements and provides a separate Heavy Metals Requisition for use by the client when ordering testing for Lead, Cadmium, Arsenic and
Mercury. Clients must provide all requested information at the time of specimen submission to enable the laboratory to meet these requirements. Required demographics
include the following: Patient's date of birth, race, complete address, telephone number, sample type (venous or capillary), guardian's name and phone number (children only),
name and address of patient's place of employment, referring physician's name, address, telephone number and UPIN. Specimens received without the required information will
not be tested. The client will be contacted and asked to submit missing
information. If such information is not received within one week of
specimen submission, the specimen will be discarded.
- Handle all specimens as if they are infectious. The greatest dangers to health care workers exposed to blood and body fluids are the Hepatitis B, Hepatitis C and HIV viruses.
- Cleveland Clinic Reference Laboratory has an extensive safety policy which adheres to guidelines provided by the Occupational Safety and Health Administration (OSHA), the Department of Labor and the Department of Health and Human Services. Written exposure control plans are in place. All specimens are handled as if they are infectious.
- All specimens should be properly sealed prior to being transported. Leaking containers pose a health hazard. Do not submit needles attached to syringes.
Test Request Form
Submit all laboratory test requests in
writing. Verbal requests are not accepted. Cleveland Clinic Reference Laboratory
provides preprinted, client specific test request
forms for use in ordering laboratory testing. Provide complete patient information on the form using block printing for accuracy. Always include the patient's medical record or
Social Security number on the form.
Note: Download Adobe Acrobat Reader to view/print Test Request Form in Portable Document Format (PDF).
Specimen Rejection Criteria
Referral Testing Policy
Unacceptable Containers
Specimen Handling:
Packing Procedures
Lead & Heavy Metal Testing
Health &
Safety Precautions
Test Request Form
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