Specimen Requirements

Submit only 1 of the following specimens:

Preferred:

Slide Fixed in 95% Alcohol and Air-Dried

1. Write patient’s full first and last name, date of birth, date of collection, and specimen source on frosted-end of a microscopic slide using a lead pencil. If applicable, add pass number to frosted-end of microscopic slide.

2. Express aspirated specimen into labeled microscopic slide.

3. Pull 2 slides together to create a thin cell spread.

4. Immediately place 1 slide into a Coplin jar containing 95% alcohol.

5. Place second slide into a 20-slide capacity cardboard slide holder to air-dry.

6. Complete a non-gynecologic cytology requisition form. Include the following information:

A. Patient’s full first and last name

B. Date of birth

C. Medical record or Social Security number

D. Date of collection

E. Submitting physician’s name. Include names of physicians to receive cytology report copies.

F. Specimen source

G. Pertinent clinical information

7. Place specimen in a plastic biohazard bag and insert non-gynecologic cytology requisition form into separate paper pouch.

8. Deliver to Histology Department.

9. Specimen rejection criteria is based on improper specimen labeling, collection, handling, or submission:

A. No non-gynecologic cytology requisition form

B. Name on requisition does not match name on specimen container or mailer

C. Unlabeled slide. Two patient identifiers are required on frosted-end of microscope slide

D. Broken slide that cannot be reconstructed

E. No physician’s name

F. Mismatch of name on non-gynecologic requisition form and name written on frosted-end of microscopic slide.

G. Slide stuck to cardboard mailer

Alternate:

Slide Fixed with Spray Fixative and Air-Dried

1. Write patient’s full first and last name, date of birth, date of collection, and specimen source on frosted-end of a microscopic slide using a lead pencil. If applicable, add pass number to frosted-end of microscopic slide.

2. Express aspirated specimen onto labeled microscopic slide.

3. Pull 2 slides together to create a thin cell spread.

4. Immediately spray 1 slide with cytology fixative and air-dry second slide.

5. Place slide into a cardboard mailer.

6. Complete a non-gynecologic cytology requisition form. Include the following information:

A. Patient’s full first and last name

B. Date of birth

C. Medical record or Social Security number

D. Date of collection

E. Submitting physician’s name. Include names of physicians to receive cytology report copies.

F. Specimen source

G. Pertinent clinical information

7. Place specimen in a plastic biohazard bag and insert non-gynecologic cytology requisition form into separate paper pouch.

8. Deliver to Histology Department.

9. Specimen rejection criteria is based on improper specimen labeling, collection, handling, or submission:

A. No non-gynecologic cytology requisition form

B. Name on requisition does not match name on specimen container or mailer

C. Unlabeled slide. Two patient identifiers are required on frosted-end of microscope slide

D. Broken slide that cannot be reconstructed

E. No physician’s name

F. Mismatch of name on non-gynecologic requisition form and name written on frosted-end of microscopic slide.

G. Slide stuck to cardboard mailer