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Palomar Health Laboratory Services
Palomar Medical Center Pomerado Hospital Palomar Health Downtown Campus
2185 West Citracado Pkwy, 15615 Pomerado Road, 555 E. Valley Pkwy,
Escondido, CA 92029 Poway CA, 92064 Escondido, CA 92025
Phone: 442-281-1571 Phone: 858-613-4358 Phone: 760-739-3030
Fax 760-233-7840 Fax 858-613-4789 Fax 760-739-2864
Directory of Laboratory Services 2013-2014
1st edition
Contact Information
Client Services
Phone numbers 760-739-2867
858-613-4282
Fax number 760-739-2864
After hours number (5 pm – 8 am)
Phone number: 442-281-1503 (PMC)
858-613-4358 (POM)
760- 613 4667 (SNF call for PMC)
Infection Control Numbers
442-281-1699
858 583 8554 (Emergency)
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Overview of Palomar Health Laboratories
Palomar Health Laboratories are full-service facilities offering comprehensive
clinical and anatomic pathology testing to the community we serve. We have 30,000
square feet of laboratory space equipped with state-of- the-art instrumentation, positive
patient identification, and patient centric culture providing high quality and most efficient
services.
Our laboratories at Palomar Medical Center, Pomerado Hospital, and Palomar
Health Downtown Campus, are accredited by the College of American Pathologist, Joint
Commission on Accreditation of Health Care Organizations, Centers for Medicare and
Medicaid Services, and State of California Department of Health Services.
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Table of Contents
I. Laboratory Certification 4
II. Laboratory Leadership 5
III. Client Services Information 6
IV. Testing Policies 7
V. Physician Client Service 8-13 a. Summary of Services 8
b. Clinical Lab, Cytology Test Requisitions 9
c. Pathology Lab Requisitions 10
d. Examples of Different Requisitions 11-13
VI. Skilled Nursing Facilities 14-18
a. Summary of Services 14
b. Weekday and Weekend Services 15
c. Holiday Schedule Services 16
d. Test Requisition Information 17
e. Standing Order procedure 18
f. Change Order Procedure 18
V. Appendix A – Specimen Requirements 19-22
VI. Appendix B – Stat Test List 23- 25
VII. Appendix C – SNF Stat Test List 26- 27
VIII. Appendix D – Critical Values 28-29
IX. Appendix E – Specimen Collection Guide 30-32
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Laboratory Certification
Fully Accredited Laboratories
Palomar Health Laboratory Services is acknowledged as a high quality laboratory and is
accredited by the following:
College of American Pathologists (CAP)
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
Centers for Medicare and Medicaid Services (CLIA)
State of California Department of Health Services (DHS)
Palomar Medical Center
CLIA ……………………………………………………………………. 05D2044832
CAP……………………………………………………………………… 8044198
Medicare Provider……………………………………………………….. 05-0115
Medical Provider ………………………………………………………..1457321317
California State Department of Health…………………………………. CLF 342634
NPI (Lab)……………………………………………………………….. 1639427685
Pomerado Hospital
CLIA …………………………………………………………. ………… 05D0668540
CAP………………………………………………………………………. 23184-01
Medicare Provider ……………………………………………………….. 050636
Medical Provider ………………………………………………………… ZZT40636F
California State Department of Health ………………………………….. CLF3150
NPI (Lab)………………………………………………………………… 1811245863
Palomar Health Downtown Campus
CLIA ……………………………………………………………………05D0671677
CAP………………………………………………………………………2314901
Medicare Provider………………………………………………………..05-0115
Medical Provider ………………………………………………………..1457321317
California State Department of Health…………………………………. CLF 1006
NPI (Lab) ……………………………………………………………… 1639427677
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Laboratory Leadership
Valley Pathology Medical Associates, Inc. Jerry Kolins, M.D. Medical Director
Blesilda Singh, M.D.
Lachlan Macleay, M.D.
Pamela Danque, M.D.
Linda Petroff, M.D.
Bradley Harward, M. D.
Saskia Boisot, M.D.
Pamela Price, M.D.
Keith Lopes, PA
Palomar Health Laboratory Services: Mark Reyes, MT (ASCP) MBA
District Director, Lab Operations
Tim Barlow, MT (ASCP)
Manager, Laboratory Services – PMC
Blood Bank Supervisor
Ted Drescher
Office/Phlebotomy Manager
Joane Barriteau, MBA/HCM, MT (ASCP)
Hematology Supervisor
Susan DeWindt, MT (ASCP)
Microbiology Supervisor
MaryAnn Snoke
Phlebotomy Supervisor - PMC
Sandy Lajeunesse, MLT (ASCP)
Central Processing Supervisor - PMC
Evelyn Chua, MT (ASCP)
Evening Shift Supervisor – PMC
Robert Sharpell, MT (ASCP)
Laboratory Info System Analyst – PMC
Gloria Austria, MBA/HCM, CLS
Manager, Laboratory Services – Pomerado
Debra Mason, MT (ASCP)
POCT Supervisor
Judy Cavallo, MT (ASCP)
Chemistry Supervisor
Rebecca Anderson, MT (ASCP)
Night Shift Supervisor – PMC
Susan David
Phlebotomy Supervisor - Pomerado
Brian Bakerink
Pathology Supervisor
Rose Pfliger
Anatomic Pathology Transcription Supervisor
Jim Peters, MT (ASCP)
Laboratory Info System Analyst – Pomerado
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Client Services
Telephone Inquiries Our Customer Service Representatives will gladly help you with your requests for test results, telephone orders,
specimen requirements, and turnaround times. After hours, please call the PHLS Client Services Department and follow
the steps to be transferred to Palomar Medical Center or Pomerado Hospital.
PHLS Client Services Department:
Phone: (760) 739-2867 or (858) 613-4282
Fax: (760) 739-2864 Hours of Operation: Monday – Friday
8:00 A.M. – 5:00 P.M.
Result Reporting Specimens are processed and test results are reported to the client as soon as possible. Since reporting times vary, a
testing schedule is available from the Outreach Laboratory office.
STAT Results available within one (1) hour after specimen is received in the laboratory.
ASAP Results are available within four (4) hours after specimen is received in laboratory.
Routine Results are available within 24 hours.
Lab Result Calling After Hours
The CLS performing the test will call critical results with no time restrictions
NOTE: The front office personnel will check the requisition for complete physician information including after hours
contact number. In the event that the information is not available the laboratory personnel will:
Call the client to get the physician information.
If information is not available or the physician cannot be reached, the CLS will call the pathologist on call.
Result Faxing:
All laboratory results will be automatically faxed to your office. This includes clinical, cytology and anatomic pathology
reports.
Critical Value Handling
The laboratory will immediately call results that fall within a range, which has been determined to be Critical or may
have an effect in delaying surgery or need to be brought to the attention of the physician. A complete list of Palomar
Health Critical Values can be found in Appendix D of this manual.
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Testing Policies “STAT” Test List:
A complete list of Outpatient “STAT” tests can be found in the Appendix B of this manual.
Repeat Determinations
We will repeat a test without charge whenever the result does not correlate, in the physician’s opinion or with the clinical
picture presented by the patient. Contact the Outreach Laboratory office with any requests for repeats. Follow-up or
confirmatory testing is not considered a repeat determination, and such specimens will therefore be processed as a new
request.
Cancellation of Tests
Cancellations received prior to test setup will be honored at no charge. Requests received following test setup or
resulting cannot be honored.
Referred Tests
Palomar Health Laboratory Services is a full service laboratory. Most tests are performed in our laboratories; however, a
few highly esoteric tests are referred to reliable reference laboratories. We use the services of ARUP Clinical
Laboratories as our primary reference laboratory. The fees for referred tests are subject to change.
Professional Courtesy
California State and Federal Laws prohibits the offering of “professional courtesy testing”; therefore we cannot honor
requests for this service.
Billing
Palomar Health will bill all insurance PPO, Medicare, Medical, and HMO insurance. However, it is the responsibility of
the patient to check with his/her insurance company prior to using our laboratory services if Palomar Health Laboratories
is a network provider of his/her insurance carrier.
Valley Pathology Medical Associates will bill for professional services provided by the pathologists. The pathologist’s
fee is normally covered by most health insurance providers. A separate bill will be sent to the patient if the insurance
does not cover the professional fee. If you have any VPMA billing questions, please contact patient representative at
888 307 6064.
Reportable Disease
All reportable diseases are reported to the County of San Diego, Public Health Department as outlined by Title 17
California Code of Regulations (17CCR). Within 24 hours of identifying a reportable organism, a Confidentiality
Morbidity Report (CMR) is completed and faxed to San Diego County Public Health.
Specimen Collection Information
A complete list of tests performed at Palomar Health Laboratories, specimen requirements, and special handling can be
found in Appendix A of this manual.
Specimen Size/Sample Size
Without adequate sample size, testing cannot be performed. This inadequate specimen collection is detrimental to patient
and patient care. Computer generated labels/ requisitions contain recommended sample sizes, tube type and
recommended handling; consult specific departments for questions regarding sample size, minimum sample volumes,
and specimen handling guidelines for tests not contained in this section.
Unacceptable Specimens
Improperly labeled/Unlabeled Specimens: Palomar Health Laboratory Services will not accept specimens
submitted without patient identification (patient name and date of birth).
o Note: In the event the specimen is identified as irreplaceable, Palomar Health Laboratory Services will
process the specimen only if authorized by the physician or client. The report will have documentation
that the specimen was received as improperly labeled or unlabeled.
Needles: Palomar Health Laboratory Services will not accept, transport or test any specimen with a needle attached.
In cases where syringes must be submitted, the syringe must be plastic and have Lauer Lock securely attached.
Glass Tubes: Glass tubes should be avoided due to the increased risk of broken glass and biological contamination.
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A. Physician Client Services
Summary of Services
Palomar Health Laboratories provide STAT and Routine Laboratory services
for physicians, medical groups, and reference laboratories. These services
include:
Client Service Department is available Monday to Friday from 8 am – 5:00 pm
Laboratory service 7 days a week
STAT turn-around-time in 60-90 minutes after specimen is received in the laboratory
Most routine results available the next day
All critical values are called to the attending physician during normal business hours or on
call physician after hours.
Laboratory reports are distributed via fax, courier, or web-based.
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Test Requisition Information
Palomar Health Laboratory Services provide four types of personalized requisition forms for your convenience. They
include:
Clinical Laboratory testing - Blue/White form
Cytology testing – Purple
Tissue/Surgical testing – Green
Skilled Nursing Facility testing- Yellow
A requisition form or physician’s order must accompany each laboratory order or specimen you submit.
I. Clinical Laboratory Testing (Blue/White Requisition) used by physicians and other laboratories when
sending specimens to Palomar Health Laboratories
Filling Out the Clinical Laboratory Testing Requisitions:
1. Patient’s full name (last, first, middle initial)
2. Current address
3. Phone number
4. Date of Birth
5. SSN, if possible
6. Check appropriate billing category and attach a copy of insurance card
7. Provide ICD-9 code(s) or chief complaint. This is a federal requirement and failure to provide may
result in insurance denial.
8. Clearly mark tests to be performed. If not listed, use the “Write-In” area.
9. Clearly label each specimen being submitted with patient’s name, date and time of collection. Use the
identification labels provided.
10. Microbiology testing – please indicate the “source” of the specimen being submitted for culture.
The back of the requisition contains a complete list of panel components, specimen collection tube codes
and reflexive tests.
II . Cytology Testing Requisition (Purple/White Requisition)
Filling Out the Test Requisition:
All fields in bold red print on the requisition slip are required fields and must be filled out prior to specimen
processing. Failure to do so may result in a delay of diagnosis.
1. Patient’s full name (last, first, middle initial)
2. Current address
3. Phone number
4. Date of Birth
5. SSN, if possible
6. Ordering physician
7. Date and time of procedure
8. Check appropriate billing category and attach a copy of insurance card
9. Provide the Clinical History, prior history or clinical symptoms of the patient.
10. Provide ICD-9 code(s) or chief complaint. This is a federal requirement and failure to provide may
result in insurance denial.
11. Provide the Clinical History, prior history or clinical symptoms of the patient.
12. Clearly mark site of specimen and laterality.
13. Clearly label each specimen being submitted with patient’s name, date and time of collection.
**Note: All “Rush” cases MUST have a direct physician contact number (preferably cell phone or
pager) provided on the submission requisition to ensure timely communication by the pathologist to
the treating physician.
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III. Pathology Testing Requisition (Green/White Requisition)
Filling out the Test Requisition:
All fields in bold red print on the requisition slip are required fields and must be filled out prior to specimen
processing. Failure to do so may result in a delay of diagnosis
1. Patient’s full name (last, first, middle initial)
2. Current address
3. Phone number
4. Date of Birth
5. SSN, if possible
6. Ordering physician
7. Date and time of procedure
8. Check appropriate billing category and attach a copy of insurance card
9. Provide the Clinical History, prior history or clinical symptoms of the patient.
10. Provide ICD-9 code(s) or chief complaint. This is a federal requirement and failure to provide may
result in insurance denial.
11. Provide the Clinical History, prior history or clinical symptoms of the patient.
12. Clearly mark site of specimen and laterality.
13. Clearly label each specimen being submitted with patient’s name, date and time of collection.
**Note: All “Rush” cases MUST have a direct physician contact number (preferably cell phone or
pager) provided on the submission requisition to ensure timely communication by the pathologist to
the treating physician.
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Palomar Health Clinical Laboratory Test Requisition
12
13
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B. Skilled Nursing Facility Client Services
1. Summary of Services
Palomar Health Laboratories provide mobile phlebotomy services across more
than 800 square miles in North San Diego County and La Jolla.
Advantages of using Palomar Health include:
Fast turn-around times
Prothrombin Time results between 10 a.m. – 12 p.m.
STAT testing results in 2 – 4 hours from your call. Most routine results before 3
p.m.
All STAT testing performed in-house 7 days a week on most tests
High quality results. Specimens are tested shortly after collection to minimize
hemolysis and ensure accuracy.
All critical values are communicated to the facility by a telephone call and fax.
Extremely competitive rates
Infection Prevention Nurses available for consultation
Serving Skilled Nursing Facilities for more than 21 years
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2. Weekday and Weekend Services
Weekdays Weekends
Routine Testing:
All routine test requests fulfilled the same
day on contracted phlebotomy days. *
Routine Testing:
Routine test requests fulfilled the day for any
test on Appendix A when requests are
phoned by 7:00 p.m.
STAT Testing:
Standard Service STAT Test Menu available
24 hours a day
STAT Testing:
Standard Service STAT Test Menu available
24 hours a day
Standing Orders:
All routine (standing) orders are fulfilled Note: Clearly mark on the requisition write in
section “Standing Order, Expiration date: _____ )
Standing Orders:
Routine (standing) orders on file are fulfilled
on Saturdays** and Sundays ** on limited
tests Note: Clearly mark on the requisition write in
section “Standing Order, Expiration date: _____ )
Time Draws:
Peak and trough therapeutic drug level
requests fulfilled as routine service on
weekdays with 24-hour prior arrangement
for the following therapeutic drugs:
Amikacin, Gentamicin, Tobramycin, and
Vancomycin
Time Draws:
Peak and trough therapeutic drug level
requests fulfilled as routine service on
weekdays with 24-hour prior arrangement
for the following therapeutic drugs:
Amikacin, Gentamicin, Tobramycin, and
Vancomycin
Facility collected specimens will be picked
up at the next scheduled phlebotomy visit
Facility collected specimens will be picked
up at the next scheduled phlebotomy visit.
Unless the specimen integrity will be
compromised, pick up will be done on the
same day.
Weekdays are defined as the period between
Monday at 4:30 am through Friday at 11:30
P.M
Weekends are defined as the period between
Friday at 11:31 P.M. through Monday 4:31
A.M.
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3. Skilled Nursing Facility Services Holiday Schedule
February President’s Day Open for regular business
May Memorial Day Closed: STAT service only
July Fourth of July Closed: STAT service only
September Labor day Closed: STAT service only
November Thanksgiving Closed: STAT service only
December Christmas Closed: STAT service only
January New year’s Day Closed: STAT service only
PLEASE NOTE OUR HOLIDAY POLICY 1. Palomar Health will accept STAT orders for tests that appear on the SNF
STAT Test menu only. (Refer to Appendix C)
2. Call all routine orders before 7:00 PM the day before the holiday.
3. Daily standing orders that fall on the holiday will be performed as
scheduled.
4. All other standing orders will be rescheduled for the business day prior
to, or the first business day following the holiday.
5. No peaks and troughs will be scheduled on the holiday.
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1. Test Requisitions Filling Out the Skilled Nursing Facility Testing Requisitions:
a. Patient’s full name (last, first, middle initial)
b. Room # and Bed #
c. Date of Birth
d. SSN, if possible
e. Check appropriate billing category and attach a copy of insurance card
f. Provide ICD-9 code(s) or chief complaint. This is a federal requirement and failure to provide may
result in insurance denial.
g. Clearly mark tests to be performed. If not listed, use the “Write-In” area.
h. Clearly label each specimen being submitted with patient’s name, date and time of collection. Use the
identification labels provided.
i. Microbiology testing – please indicate the “source” of the specimen being submitted for culture.
j. For Standing Orders: Write “Standing Order” in the Write order/Special Instruction area and the
expiration date of the standing order.
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2. New Routine Standing Order Procedure *A standing order is valid until its expiration date, but no longer than 12 months
a. To initiate a routine (standing) Order, use the Palomar Health (triplicate) requisition
form.
b. Write in “Standing Order, Expiration Date______” once a week or every Monday as
an example.
c. Complete all required information, patient name, date of birth, room #, bed#, billing
information, tests ordered”
File the completed requisition in the card file by the first letter of the last name.
3. Change Order Form for Pre-Existing Routine (standing) Order
a. Palomar Health requires written authorization to change pre-existing routine
(standing) orders to be in compliance with the State law and the Office of the
Inspector General of the Department of Health and Human Services.
b. Please write the appropriate change/s below. c. Authorized person must sign and date the form.
d. Fax the form to the appropriate location marked on the form (Palomar or Pomerado)
e. For new orders, a new requisition must be filled out.
SNF Change Order Form
Palomar Medical Center Pomerado Hospital
2185 W. Citracado Pkwy., 1 5615 Pomerado Road,
Escondido, CA 92029 Poway, CA 92064
Phone:442 281 1571 Phone: 858 613 4358
Fax: 760 233 7840 Fax: 858 613 4789
DO NOT USE FOR NEW ORDERS
Attention: Director of Nurses/Medical Director
Palomar Health requires written authorization to change pre-existing routine (standing) orders to be in compliance with the State law
and the Office of the Inspector General of the Department of Health and Human Services. Please write the appropriate change/s
below. Sign, date, and fax the form to the marked location (Palomar or Pomerado)
Orders MUST be received before 3:30 P.M. Monday – Friday in order to be processed
Please check action/s that applies:
Add on Test Cancel Test Change Order
Note: For Change Order please fill out a new requisition
FACILITY: _____________________________
Resident’s Name: ____________________ Sex: ________ Room #: ____
Date of Birth: _____________________ Diagnosis Code: _____________
Physician: ______________________ Physician Phone: _____________
( Last, First name)
Test(s) Added-on: ______________________________________________
Test(s) Canceled: ______________________________________________
Authorized by: _____________________ Date:__________ Time: ____
Signature: ___________________
For Palomar Health Use only:
Patient’s MRN: ______________________________
Original Accession #: _________________________
Date and Time Collected: ______________________ Completed by : _____________________ Date: ___________
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Appendix A
Specimen Requirements
Test Submission
Requirements / Tube Color
Special Handling
ABG (Arterial Blood Gas) 1 ml Li Heparin syringe ABG kit on Ice
ABO typing 7 ml/lavender
ABORh 7 ml/lavender
Acetaminophen (Tylenol) 5 ml/PST / SST
Albumin 5 ml/PST /SST
Alcohol, Ethyl (Ethanol) 5 ml/SST/PST Do not prep site with alcohol;
Alkaline Phosphatase 5 ml/PST /SST
ALT (SGPT) 5 ml/PST / SST
Ammonia (NH4) 5 ml/PST Deliver on ice - STAT.
Amylase 5 ml/PST / SST
Antibody Screen 7 ml/lavender
Anti-HAV IgM(Hep A virus AB, IgM)
6.5 ml/SST
Anti-HBC IgM (Hep B virus AB, IgM)
6.5 ml/SST
Anti-HCV (Hep C virus AB) 6.5 ml/SST
APTT 3 ml/LT blue (4.5 ml/LT blue preferred)
Return to lab ASAP.
Arthritis Profile 5 ml/SST & 3 ml/lavender
ASO Screen (Anti-Streptolysin) 6.5 ml/SST
AST (SGOT) 5 ml/PST / SST
B12, Vitamin 5 ml/PST / SST
Bicarb (arterial) 3 ml/green Do not spin.
Bilirubin, Direct 5 ml/PST / SST Avoid hemolysis.
Bilirubin, Total 5 ml/PST / SST
Avoid hemolysis.
Blood Culture
8-10 ml/BACTEC (aer grey bottle) 8-10 ml/BACTEC (anaer purple bottle)
Consult Departmental Procedure for additional instructions.
Blood Culture Peds 1 -3 ml/BACTEC (Peds aer pink bottle)
Blood Culture
Special instruct: If 10-20 ml, split evenly between aer & anaer: 3-9ml add to aer; <3ml add all to peds
BUN (Blood Urea Nitrogen) 5 ml/PST / SST
Calcium 5 ml/PST / SST
Calcium, Ionized 3 ml/green lithium heparin NON GEL
Deliver on ice – ASAP (NON-GEL tube)
Carbamazepine(Tegretol) 5 ml/PST / SST
Carboxyhemoglobin 7 ml/green or a heparinized syringe
Deliver ASAP
CBC (Complete blood count) 3 ml/lavender
CBC w/Differential 3 ml/lavender
CEA (Carcinoembryonic Antigen) 5 ml/SST
Chem 12(Na, K, Cl, Glucose, BUN, Creat, Calcium, T. Prot, Alb, AST, Alk Phos, T. Bili
5 ml/PST / SST
Chem + HDL 5 ml/PST / SST Fasting required.
Cholesterol 5 ml/PST / SST
20
Test
Submission
Requirements / Tube Color
Special Handling
CK (CPK, Creatine Kinase) 5 ml/PST / SST
Cl (Chloride) 5 ml/PST / SST
Coombs, Direct 7 ml/lavender
Coombs, Indirect 7 ml/lavender
C-Reactive Protein, Acute 5 ml/PST / SST
C-Reactive Protein, Cardiac 5 ml/PST / SST
Creatinine 5 ml/PST / SST
Cross-Match (Type and Cross) 7 ml/lavender Patient must be BB banded.
D-Dimer 3 ml/LT blue (4.5 ml/LT blue preferred)
Digoxin 5 ml/PST / SST Collect >5hr post dose.
Dilantin(Phenytoin, PTN) 5 ml/PST / SST
Electrolytes (Na, K, Cl, CO2) 5 ml/PST / SST
ESR (Erythrocyte Sedimentation Rate; Sed Rate)
3 ml/lavender
Estradiol
5 ml/SST
FDP 2 ml/Special DK Blue tube w/yellow label
Ferritin 5 ml/PST / SST
Fibrinogen 3 ml/LT blue (4.5 ml/LT blue preferred)
Folate/Vitamine B12 5 ml/SST/PST
Folic Acid 5 ml/PST / SST
Free T4 (Free Thyroxine, FT4) 5 ml/PST / SST
FSH (Follicle Stimulating Hormone)
5 ml/SST
Gentamicin (tr or pk) (Garamycin) 5 ml/PST / SST
GGT (Gamma-Glutamyl Transferase)
5 ml/PST / SST
Glucose (Blood sugar) 5 ml/PST / SST / Gray
Glucose, PG 50(post 50 gms Glucola)
5 ml/PST / SST / Gray Consult PG 50 collect procedures
Glucose, 2 hr PP 5 ml/PST / SST / Gray Collect 2 hrs post meal.
Glucose Tolerance test (Specify 3,4,5,6 hr) (GTT)
5 ml/gray each hour Consult GTT collection procedure
Glycohemoglobin (Glycosylated Hemaglobin A1C)
3 or 7 ml/lavender Do not spin.
HBSAg 5 ml/SST Must be drawn in separate tube. Send original tube
HCG (Qual or Quant) 5 ml/SST (Urine for Qual)
HDL(High Density Lipoprotein) 5 ml/PST / SST Fasting required.
HDL/LDL 5 ml/PST / SST Fasting required.
Hematocrit (CBC) 3 ml/lavender
Hematology tests (CBC, sed rate, retic count)
3 ml/lavender
Hemogram (CBC) 3 ml/lavender
Hepatic Panel (Liver panel) 5 ml/PST / SST
Hepatitis Evaluation (or any Hepatitis testing)
5 ml/SST all = 7 ml/SST Must be drawn in separate tube. Send original tube
Hgb A1C (Hemoglobin A1C) 3 or 7 ml/lavender Do not spin.
Homocysteine 4.5 ml lavender
21
Test Submission
Requirements /Tube Color
Special Handling
Ionized Calcium 3 ml/green(non gel tube ) /Heparin
Deliver on ice ASAP.(Non gel tube)
Iron 5 ml/PST / SST
LA (Lactic Acid) 3 ml/green/Heparin Deliver on ice ASAP.
LD (Lactate Dehydrogenase; LDH) 5 ml/PST / SST Avoid hemolysis.
LH (Luteinizing Hormone) 5 ml/SST
Lipase 5 ml/PST / SST
Lipid Profile / Panel (includes: Cholesterol, Trig, HDL, LDL, Risk Ratios)
5 ml/PST / SST Fasting required.
Lithium 5 ml/SST
Liver Function / Panel (ALB, ALK PHOS, AST, ALT, T Bili, LD, T Prot)
5 ml/PST / SST
Magnesium 5 ml/PST / SST
Methemoglobin 7 ml/green Deliver on ice.
Mini Panel (Na, K, Cl, CO2, BUN, Creatinine, Glucose, Calcium)
5 ml/PST / SST
Mono Spot 5 ml/SST
Na (Sodium) 5 ml/PST / SST
O2 Saturation (Oxygen % Saturation)
2 ml/Heparinized syringe
OB Profile (Includes: HBsAg, CBC, Rubella, RPR, ABORh, Antibody Screen)
3ml lavender & 2-6 ml SST
Partial Thromboplastin Time (PTT, APTT)
3 ml/LT blue (4.5 ml/LT blue preferred)
pH-Arterial 2 ml/Heparinized syringe
pH-Venous 7 ml/green
Phenobarbital (Luminal) 5 ml/PST / SST
Phenytoin (Dilantin; Diphenylhydantoin)
5 ml/PST / SST
Phosphorus (PO4) 5 ml/PST / SST
Potassium (K+) 5 ml/PST / SST Avoid hemolysis.
Platelet Function Epinephrine (PFA)
4.5 ml /blue/GLASS only Stable for 4 hours after collection, room temperature only, DO NOT SPIN , DO NOT Refrigerate
Prealbumin 5 ml/PST / SST
Pregnancy (Qual) 5 ml/SST or urine
Prenatal HbsAg 5 ml/SST
Progesterone 7 ml/SST
Prostate Specific Antigen (PSA) 5 ml/SST
Protein, Total 5 ml/PST / SST
Prothrombin Time (PT; Protime) 3 ml/LT blue (4.5 ml/LT blue preferred)
Deliver to lab ASAP.
PSA (Prostate Specific Antigen) 5 ml/SST
PTH 5 ml/SST
RF (Rheumatoid Arthritis) 5 ml/PST / SST
Rapid Plasma Reagin (RPR) 5 ml/SST
Renal Panel (Na, K, Cl, CO2, Glucose, Creat, Uric Acid, Calcium, Phos)
5 ml/PST / SST
Reticulocyte Count (Retic) 3 ml/lavender
RPR (Rapid Plasma Reagin) 5 ml/SST
22
Test Submission
Requirements /Tube Color
Special Handling
Salicylate 5 ml/PST / SST
Sed Rate 3 ml/lavender
SGOT (AST) 5 ml/PST / SST
SGPT (ALT) 5 ml/PST / SST
Sodium (Na+) 5 ml/PST / SST
T-4, Free (FT4, Free Thyroxine) 5 ml/PST / SST
T-4, Total (Thyroxine) 5 ml/PST / SST
Tegretol (Carbamazepine) 5 ml/PST / SST
Theophylline (Aminophylline) 5 ml/PST /SST Document time last dose.
Thyroid Stimulating Hormone 5 ml/PST / SST
Thyroxine (T4) 5 ml/PST / SST
TIBC (Total Iron Binding Capacity) 5 ml/PST / SST
Tobramycin (Nebcin) 5 ml/PST / SST Peak/trough collection; consult policy.
Total Bilirubin 5 ml/PST / SST Avoid hemolysis.
Total Iron Binding Capacity (TIBC) 5 ml/PST / SST
Total Protein 5 ml/PST / SST
Transferrin 5 ml/PST / SST
TSH 5 ml/PST / SST
Uric Acid 5 ml/PST / SST
Urinalysis 3 ml/urine (minimum)
Urine Culture 1 ml/urine (minimum)
Valproic Acid (Depakene; Depakote)
5 ml/PST / SST
Vancomycin (Vancocin) 5 ml/PST / SST Peak/trough collection; consult policy; contact nursing staff prior to collection.
Vitamin B12 5 ml/PST / SST
Vitamin B12/Folate 5 ml/PST / SST
Vitamin D (Vit D 25 DH ) 5 ml/PST / SST
Pathology Test Requirements:
Routine Histology Formalin 5% Zinc Formalin Routine pickup
Frozen section Fresh tissue Call for Stat pickup
Chromosome analysis (POC) Fresh tissue Call for Stat pickup
Flow Cytometry Fresh tissue Call for Stat pickup
Cytology Test Requirements:
Body cavity fluid (includes sputum) Fresh fluid- refigerated Routine pickup
Fine needle aspiration/biopsy Cytorich fixative Routine pickup
Smears/Slides 95% Alcohol fixative Routine pickup
CSF Cytorich fixative Routine pickup
23
Appendix B
STAT List Orderable Section Turn Around Time FACILITY
ABORh Blood Bank 1 hour PMC, POM, PHDC
Acetaminophen Level Chemistry 1 hour PMC, POM, PHDC
Albumin Level Blood Chemistry 1 hour PMC, POM, PHDC
Alcohol Level Blood Chemistry 1 hour PMC, POM, PHDC
Alkaline Phosphatase Chemistry 1 hour PMC, POM, PHDC
ALT Chemistry 1 hour PMC, POM, PHDC
Ammonia Level Chemistry 1 hour PMC, POM, PHDC
Amylase Blood Chemistry 1 hour PMC, POM
Antibody Screen Blood Bank 1 hour PMC, POM, PHDC
AST Chemistry 1 hour PMC, POM, PHDC
Beta-Hydroxybutyrate Chemistry 1 hour PMC, POM, PHDC
Bilirubin Direct Chemistry 1 hour PMC, POM, PHDC
Bilirubin Indirect Chemistry 1 hour PMC, POM, PHDC
Bilirubin Total Chemistry 1 hour PMC, POM, PHDC
Blood Gas Arterial Chemistry 1 hour PMC, POM, PHDC
Blood Gas Arterial Cord Chemistry 1 hour PMC, POM, PHDC
Blood Gas Capillary Chemistry 1 hour PMC, POM, PHDC
Blood Gas Venous Chemistry 1 hour PMC, POM, PHDC
Blood Gas Venous Cord Chemistry 1 hour PMC, POM, PHDC
BMP-Mini Panel Chemistry 1 hour PMC, POM, PHDC
BNP Chemistry 1 hour PMC, POM
Body Fluid Albumin Chemistry 1 hour PMC, POM, PHDC
Body Fluid Amylase Chemistry 1 hour PMC, POM
Body Fluid Cell Count Hematology 1 hour PMC, POM, PHDC
Body Fluid Chloride Level Chemistry 1 hour PMC, POM, PHDC
Body Fluid Creatinine Chemistry 1 hour PMC, POM, PHDC
Body Fluid Crystal Exam Hematology 1 hour PMC, POM, PHDC
Body Fluid Glucose Chemistry 1 hour PMC, POM, PHDC
Body Fluid LD Chemistry 1 hour PMC, POM
Body Fluid Osmolality Chemistry 1 hour* PMC
Body Fluid pH Chemistry 1 hour PMC, POM, PHDC
Body Fluid Potassium Level Chemistry 1 hour PMC, POM, PHDC
Body Fluid Protein Chemistry 1 hour PMC, POM, PHDC
Body Fluid Sodium Level Chemistry 1 hour PMC, POM, PHDC
Body Fluid Specific Gravity Hematology 1 hour PMC, POM, PHDC
BUN Chemistry 1 hour PMC, POM, PHDC
Calcium Level Blood Chemistry 1 hour PMC, POM, PHDC
Calcium Level Ionized Chemistry 1 hour PMC, POM, PHDC
Carbamazepine Level Chemistry 1 hour PMC, POM
Carbon Dioxide Blood Chemistry 1 hour PMC, POM, PHDC
Carboxyhemoglobin Blood Chemistry 1 hour PMC, POM, PHDC
CBC Hematology 1 hour PMC, POM, PHDC
CBC w/ Differential Hematology 1 hour PMC, POM, PHDC
Chem Panel Chemistry 1 hour PMC, POM, PHDC
Chloride Level Blood Chemistry 1 hour PMC, POM, PHDC
24
Orderable Section Turn Around Time FACILITY
CK Chemistry 1 hour PMC, POM, PHDC
CKMB Chemistry 1 hour PMC, POM, PHDC
Clost difficile tox A/B Ag by EIA Microbiology 1 hour PMC, POM, PHDC
Cooximetry Chemistry 1 hour PMC, POM, PHDC
Creatinine Blood Chemistry 1 hour PMC, POM, PHDC
CSF Cell Count Hematology 1 hour PMC, POM, PHDC
CSF Chloride Level Chemistry 1 hour PMC, POM, PHDC
CSF Glucose Chemistry 1 hour PMC, POM, PHDC
CSF Lactic Acid Chemistry 1 hour PMC, POM, PHDC
CSF LD Chemistry 1 hour PMC, POM
CSF Protein Chemistry 1 hour PMC, POM, PHDC
D-Dimer Coagulation 1 hour PMC, POM, PHDC
Digoxin Level Chemistry 1 hour PMC, POM, PHDC
Du test Blood Bank 1 hour PMC, POM, PHDC
Electrolyte Panel Chemistry 1 hour PMC, POM, PHDC
Eosinophil Count Total Hematology 1 hour PMC, POM, PHDC
Fibrin Degradation Products Coagulation 1 hour PMC, POM, PHDC
Fibrinogen Coagulation 1 hour PMC, POM, PHDC
Fibronectin Chemistry 1 hour * PHDC
Gentamicin Level Peak Chemistry 1 hour PMC, POM
Gentamicin Level Random Chemistry 1 hour PMC, POM
Gentamicin Level Trough Chemistry 1 hour PMC, POM
GGT Chemistry 1 hour PMC, POM
Glucose Blood Chemistry 1 hour PMC, POM, PHDC
Gram Stain Microbiology 1 hour PMC, POM, PHDC
HCG Qualitative Hematology 1 hour PMC, POM, PHDC
HCG Quantitative Chemistry 1 hour PMC, POM, PHDC
Hepatitis B Surface Antigen Chemistry 1 hour* POM
HIV Rapid 1 & 2 Chemistry 1 hour PMC, POM, PHDC
India Ink Microbiology 1 hour* PHDC
Influenza A & B by PCR Microbiology 4 hours *PHDC
Iron Level Chemistry 1 hour PMC
KOH Microbiology 1 hour PMC, POM, PHDC
Lactic Acid Blood Chemistry 1 hour PMC, POM
LD Blood Chemistry 1 hour PMC, POM
Lipase Level Chemistry 1 hour PMC, POM
Lithium Level Chemistry 1 hour* PMC
Liver Panel Chemistry 1 hour PMC, POM, PHDC
Magnesium Level Blood Chemistry 1 hour PMC, POM, PHDC
Malaria Smear Hematology 1 hour* PMC
Methemoglobin Chemistry 1 hour PMC, POM, PHDC
Mono Screen Serology 1 hour PMC, POM, PHDC
Osmolality Blood Chemistry 1 hour* PMC
Ova and Parasites (Direct Mount Only) Microbiology 1 hour* PHDC
pH Blood Venous Chemistry 1 hour PMC, POM, PHDC
Phenobarbital Level Chemistry 1 hour PMC, POM
Phenytoin Level Chemistry 1 hour PMC, POM
Phosphorus Level Blood Chemistry 1 hour PMC, POM, PHDC
Platelet Count Automated Hematology 1 hour PMC, POM, PHDC
Platelet Function Aspirin Coagulation 1 hour* PMC
25
Orderable Section Turn Around Time FACILITY
Platelet Function Epinephrine Coagulation 1 hour PMC, POM
Platelet Function P2Y12 (Plavix Inhibitor) Coagulation
1 hour* PMC
Potassium Level Blood Chemistry 1 hour PMC, POM, PHDC
Procainamide Level Chemistry 1 hour* PMC
Protein Blood Total Chemistry 1 hour PMC, POM, PHDC
Protime Coagulation 1 hour PMC, POM, PHDC
PTT Coagulation 1 hour PMC, POM, PHDC
Renal Panel Chemistry 1 hour PMC, POM, PHDC
Respiratory Syncytial Virus by EIA Microbiology 1 hour PMC, POM, PHDC
Retic Count Hematology 1 hour* PMC,PHDC
Rh Typing Blood Bank 1 hour PMC, POM, PHDC
Rhogam Workup Blood Bank 1 hour POM, PHDC
Rotavirus by EIA Microbiology 1 hour* PHDC
Salicylate Level Chemistry 1 hour PMC, POM, PHDC
Sed Rate Hematology 1 hour PMC, POM, PHDC
Sodium Level Blood Chemistry 1 hour PMC, POM, PHDC
Strep Gr A Rapid Immunoassay Microbiology 1 hour PMC, POM, PHDC
Theophylline Level Chemistry 1 hour PMC, POM
Tobramycin Level Peak Chemistry 1 hour PMC, POM
Tobramycin Level Random Chemistry 1 hour PMC, POM
Tobramycin Level Trough Chemistry 1 hour PMC, POM
Troponin I Chemistry 1 hour PMC, POM, PHDC
TSH Chemistry 1 hour PMC, POM, PHDC
Type and Cross Blood Bank 1 hour PMC, POM, PHDC
Type and Screen Blood Bank 1 hour PMC, POM, PHDC
Uric Acid Blood Chemistry 1 hour PMC, POM
Urinalysis Screen Dipstick Urinalysis 1 hour PMC, POM, PHDC
Urinalysis Sedimentation Microscopic Urinalysis
1 hour PMC, POM, PHDC
Urine Drug Screen (In House Test) Chemistry 1 hour PMC, POM, PHDC
Valproic Acid Level Chemistry 1 hour PMC, POM
Vancomycin Level Peak Chemistry 1 hour PMC, POM
Vancomycin Level Random Chemistry 1 hour PMC, POM
Vancomycin Level Trough Chemistry 1 hour PMC, POM
WBC Smear Microbiology 1 hour PMC, POM, PHDC
Wet Mount Microbiology 1 hour PMC, POM, PHDC
*1 hour turn-around time if specimen is delivered directly to the performing facility
26
Appendix C
Skilled Nursing Facility Client STAT Services Acetaminophen Level
Acetone
Albumin Level Blood
Alcohol Level Blood
Alkaline Phosphatase
ALT
AST
Bilirubin Direct
Bilirubin Indirect
Bilirubin Total
Blood Gas Arterial
Blood Gas Venous
BMP-Mini Panel
BNP
BUN
Calcium Level Blood
Calcium Level Ionized
Carbamazepine Level
Carbon Dioxide Blood
Carboxyhemoglobin Blood
CBC
CBC w/ Differential
Chem Panel
Chloride Level Blood
CK
CKMB
Cooximetry
Creatinine Blood
D-Dimer
Digoxin Level
Electrolyte Panel
Fibrin Degradation Products
Fibrinogen
Gentamicin Level Peak
Gentamicin Level Random
Gentamicin Level Trough
GGT
Glucose Blood
Gram Stain
HCG Qualitative
HCG Quantitative
KOH
Lactic Acid Blood
LD Blood
Lipase Level
Liver Panel
Magnesium Level Blood
27
Methemoglobin
Mono Screen
pH Blood Venous
Phenobarbital Level
Phenytoin Level
Phosphorus Level Blood
Platelet Count Automated
Potassium Level Blood
Procainamide Level
Protein Blood Total
Protime
PTT
Renal Panel
Respiratory Syncytial Virus by EIA
Retic Count
Salicylate Level
Sed Rate
Sodium Level Blood
Strep Gr A Rapid Immunoassay
Theophylline Level
Tobramycin Level Peak
Tobramycin Level Random
Tobramycin Level Trough
Troponin I
Uric Acid Blood
Urinalysis Screen Dipstick
Urinalysis Sedimentation Microscopic
Urine Drug Screen (In House Test)
Valproic Acid Level
Vancomycin Level Peak
Vancomycin Level Random
Vancomycin Level Trough
WBC Smear
Wet Mount
28
Appendix D
Palomar Health Laboratories Critical Values Table
Table 1. Blood Gas, Coagulation, Chemistry, and Hematology
Test Unit Critical Values
Low High
Blood Gases pH, Arterial or Venous N/A <7.20 >7.60
pCO2, Arterial or Venous mm Hg n/a >60
pO2, Arterial mm Hg <50 N/A
Chemistry Calcium, Total mg/dl <6.0 >13.5
CO2 mmol/L <10 >50
Glucose mg/dl <40 >500
Magnesium mg/dl <1.0 >6.9
Phosphorus mg/dl <1.0 > 12.0
Potassium mmol/L < 2.8 > 6.2
Sodium mmol/L <120 >160
Urea Nitrogen (BUN) mg.dL N/A N/A
Coagulation Prothrombin Time – INR N/A N/A >4.0
Partial Thromboplastin Time (PTT) seconds N/A > 150
Hematology Absolute Neutrophil Count (ANC) X1000 mm3 < 0.5 N/A
Hematocrit % <19.8 >70
Hemoglobin g/dL < 6.6 > 23
Platelet X1000 mm3 <20 >1000
White Blood Cells X1000 mm3 < 1.0 N/A
Table 2. Therapeutic Drugs
Test Unit Therapeutic Drugs
Through Peak Gentamicin mcg/mL >2.0 >25
Tobramycin mcg/mL >2.0 >25
Vancomycin mcg/mL >25 >50
Test Unit Potentially Toxic Values Carbamezapine mcg/mL >15
Digoxin mcg/mL >2.2
Lithium mcg/mL >1.5
Phenobarbital mcg/mL >50
Phenytoin mcg/mL >25
Theophylline mcg/mL >20
Valproic Acid mcg/mL >200
29
Table 3. Microbiology
Malarial smears - Any positive
Blood Culture - Any positive
CSF Gram Stain or Culture – Any positive
Gram Stain or Culture from any sterile body fluid – Any positive
CSF Latex antigens – Any positive
India Ink – Any positive
Gram Stain or culture on tissue abscess or aspirate from a visceral organ (ex. lung, liver,
or brain - Any positive
Carbapenem resistant Enterobacteriaceae
Extended spectrum Beta lactamase producing organism Methicillin Resistant Staphylococcus aureus (MRSA) with a MIC as caused of an infection
Vancomycin Resistant Enterococci (VRE) with a MIC as caused of an infection
Stool Positive for Clostridium difficile Toxin A and/or B
Table 4. Anatomic Pathology
All first time malignant diagnoses (with the exception of carcinoma of the skin).
Absence of chorionic villi when clinically expected (potential ectopic pregnancy)
Change of a frozen section diagnosis after review of permanent sections.
Significant unexpected findings and/or significant discordant pre-op and post-op diagnoses.
Mycobacterial, fungal or other significant infectious organisms identified on special stains.
30
Palomar Health Specimen Collection Guide
Transport Container Test(s) Transport Container Test(s)
E Swab
Aerobic wound
Anaerobic wound
Cervical Culture
Throat Culture (not
rapid Group A screen)
Yeast Screen
Strep A or B Culture
Screen
MRSA or VRE Culture
Screen NOTE: DO NOT collect
body fluid and tissue with a
swab, send in sterile
container
Room Temperature
Sterile Container
Urine Culture Stool Culture Stool for WBC C.Diff toxin Rapid Rotavirus Ova and Parasites Tissue Culture* Body Fluid* Sputum Nasopharyngeal
wash for a. Rapid RSV
b. Rapid Influenza
A/B Catheter tip*
*Room Temperature,
all others refrigerate
BBL Red Top Double
Swab or White Top
Single Swab
Rapid Group A Strep Vaginal Wet Mount
KOH
NOTE: DO NOT use for
tissue, body fluid or
anaerobic wound
Room Temperature
UTM w/ Flocked
Swab
Viral culture (DFA
or PCR)
Mycoplasma
culture
Ureaplasma culture
Chlamydia culture
Rapid Influenza
A/B
Rapid RSV
Refrigerate
BBL Green Top-Mini
Tip
Pertussis
Culture/DFA/PCR
[nasopharyngeal( NP)
swab]
Eye Culture
Urethral Culture
NOTE: Collect 1 NP swab
for each test method
Room Temperature
Copan Red Capped
Swab with RED
Lettering on Plastic
Tube
Group B Strep
Screen by PCR
MRSA Nasal
Screen by PCR
Room Temperature
31
Transport Container Test(s) Transport Container Test(s)
Urine C&S Preservative
Tube
Urine for Culture and
Sensitivity, not
acceptable for urinalysis
Note: Fill the tube with
urine up to fill line
(minimum of 4 ml)
Room Temperature
Hemosure
Fecal Occult Blood
GC/Chlamydia Aptima
Collection Kit
Nucleic Acid
Amplification Test
(NAAT)
Endocervical or Male
urethral swab
Urine – collect in sterile
urine container Refrigerate
Rapid Clearview
Chlamydia
Red Top Copan Swab
– NO SPONGE in the
bottom of container
Female Endocervical
Specimens ONLY
< 24 hours Room
Temperature
≥ 24 hours Refrigerate
Blood Culture Room Temperature
Amount per
Venipuncture
Amount in
BACTEC Plus Aerobic Vial
Amount in
BACTEC Plus
Anaerobic Vial
Amount in
BACTEC Ped Plus
Vial
16 – 20 mL Split equally between aerobic and anaerobic vials
13 – 16 mL 8 mL 5 – 8 mL
10 – 12 mL 5 – 7 mL 5 mL
3 – 9 mL entire blood amount 0
< 3 ml entire blood amount
32
Transport Container Test(s) Transport Container Test(s)
UA Screen and
Culture & Sensitivity
Transport
Urinalysis w/
culture
Urinalysis w/
Culture if
indicated
Note: Submit both
urine cup and urine
tube with boric acid
(UBOR) to the lab)
Refrigerate Urine Cup only
QuantiFERON-TB
Gold Tubes
Shake tubes 10
times
Room Temperature
Platelet Function
Assay (PFA-EPI) AKA Platelet Function
Epinephrine
NOTE: 4.5 ml
GLASS tube only. DO
NOT use plastic tubes.
DO NOT SPIN
Room Temperature
Platelet Function
PF P2Y12 (Plavix
Inhibition)
PF Aspirin
NOTE: 2.0 ml Special
partial fill Blue Top
tube
DO NOT send platelet
function test tubes via
pneumatic tube system
DO NOT Spin
Room Temperature
