Specimen Requirements

Collect specimen as follows:

1. Write patient’s full first and last name, date of birth, date of collection, and specimen source (left or right) on    

    frosted-end of a microscope slide using a lead pencil.

2. Smear a pea sized drop of fluid across a labeled microscopic slide.

3. Immediately place slide in a Coplin jar containing 95% alcohol or spray with cytology spray fixative.

4. Place sprayed slide into a cardboard mailer.

5. 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 (left or right)

    G. Pertinent clinical information

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

    paper pouch

7. Deliver to Histology Department

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

    A. Specimen that has leaked into plastic biohazard bag

    B. No non-gynecologic cytology requisition form

    C. Name on requisition does not match name on specimen container

    D. Unlabeled specimen container or slide. Two patient identifiers are required on both the specimen

         container and the frosted-end of the microscope slide.

    E. Broken slide that cannot be reconstructed

    F. Slide not spray-fixed

    G. Slide stuck to cardboard mailer

    H. No physician’s name