Order Clarification Tool

St. Luke’s Laboratory

Laboratory test orders often include complex components. It must be clear to the ordering physician what is included in each test order. This chart is a tool for building order sets or forms, include the parenthetic information on each order sheet:

Unacceptable test order
CBC w/Differential Hematology Profile CBC w/Manual Differential
Manual Differential / Acceptable test order
CBC W/AUTO DIFFERENTIAL
CBC W/OUT DIFFERENTIAL
CBC W/MANUAL DIFFERENTIAL
BLOOD SMEAR MANUAL WBC DIFF
BLOOD COUNT AUTO WBC DIFF
CBC indices
CBC w/platelet
CBCD / CBC W/AUTO DIFFERENTIAL
Complete (CBC), automated and automated differential WBC count.
Hematology differentials that fit the following criteria upon original finding will be referred to a hematopathologist who will decide whether a written report should follow:
 Markedly abnormal RBC morphology
 Greater than 3 nucleated RBC’s (excluding newborns)
 If the WBC is less than 1,000/cmm or greater than 30,000/cmm.
 If immature WBC’s are present: promyelocytes or blasts
 If the number of lymphocytes is greater than 7,500/cmm.
 If the number of platelets is less than 20,000/cmm or greater than 750,000/cmm
 If the hemoglobin is less than 7 gms or greater than 19 gms.
 Presence of microorganisms.
CBC W/OUT DIFFERENTIAL (does not include differential)
CBC W/MAN DIFF
MANUAL WBC DIFFERENTIAL
Blood smear, microscopic examination with manual diff WBC count
AUTO WBC DIFFERENTIAL
Blood smear, automated WBC count
WBC
PLT
HGB
HCT
CMP / CMP (Includes Alb, TBili, Calcium total, CO2, CL, Creat, Gluc, Alk Phos, K, Tot Prot, Na, ALT, AST, Urea Nitrogen)
BASIC / BMP (Includes Ca tot, CO2, CL, Creat, Gluc, K, Na, Urea Nitrogen)
Electrolytes/Lites / Electrolyte Panel (Includes CO2, CL, K, NA)
Hepatic / Hepatic Panel (Includes Alb, TBili, DBili, Alk Phos, T Prot, ALT, AST)
Lipid Panel / Lipid Panel (Includes Chol, HDL Chol and Trig. If Trig greater than 400 ng/dl, a direct LDL)
Hepatitis Panel / Hepatitis Panel (Includes Hep A AB (IGM), Hep B core AB (IGM), Hep B Surf Antigen and Hep C antibody)
Renal Function Panel / Renal Panel (Includes Sodium, Potassium, Chloride, CO2, Albumin, Calcium, Creat, Gluc, Phos, and Urea Nitrogen)
Iron and TIBC (combined) / Iron
Iron Binding Capacity (includes Iron and % Transferrin saturation)
Transferrin
sTSH / TSH
TSH Reflex / TSH Reflex (Reflexes to FT4 and/or FT3 if Abnormal)
Type & Screen
Type and Cross
Crossmatch / Type & Screen (Includes ABO, Rh & AB Screen, pos AB screen reflexes to AB ID and Crossmatch 2 units PC)
Type & Screen (Includes ABO, Rh & AB Screen, pos AB screen reflexes to AB ID and Crossmatch 2 units ahead of order) & Crossmatch ____Units of:____
Type & Hold / Extra Tube Blood Bank (A Blood Bank identification wristband must be completed at the time of collection, which will allow the sample to be used for a Type & Screen and Crossmatch if ordered after draw)
UA / UA, (Reflexes to microscopic and/or culture if abnormal. Reflexive Culture if under the age of 10)If a UA is ordered; the microscopic will be done if the protein, nitrate and/or leukocyte esterase is positive; if the blood is greater than trace or if the glucose is greater than 1 g/dL. There is no additional charge for the microscopic. If the nitrate and or leukocyte esterase are positive and/or if there are more than 10 WBC present in the microscopic exam, a urine culture will be ordered (except in the Emergency Department or Urgent Care unless the patient is admitted from ED/UC within 5 hours). Urine Culture (The urine culture will be ordered on catheter urines from children under the age of 10)
UA / UADIP, (Urine Macroscopic only)
UA / UM, (includes Macroscopic and Microscopic, will NOT reflex a culture)
CK or CKMB / CKMB Reflex (Reflexes to CK, total and % CKMB if CKMB >5 ng/ml)
MI Profile / No lab test, these are order sets
Strep Screen / Strep Screen (Negative Reflexes to throat culture except in ED or UC)
Group B Strep by PCR / Group B Strep by PCR, Reflex to Culture if indeterminate.
Lyme / Lyme, Reflexive (Reflexes to Western Blot Confirmation if positive )
Streptozyme / Streptozyme (Reflexes to titer if positive)
ASO / ASO Protocol (Streptozyme Screen, reflexes to ASO titer and Anti-Dnase B titer if positive)
RPR, VDRL / RPR (Reflex to FTA, confirm if positive)
HCV / HCV (Reflex to Recombinant Immunoblot Assay if s/co ratio 1.0 to 10.9)
HIV 1/0/2 / HIV 1/0/2 ( Reflex to Western Blot if reactive)
Monospot / Mono w/option to reflex to EBV (if reflex option selected, negative Monospot reflexes to EBV panel)
Body Fluid Cell Count (Reflex to differential if >10 nucleated Cells)
O&P / O&P Screen (includes Giardia and Cryptosporidium antigens)
O&P Complete / O&P Complete Exam (includes identification of significant ova & parasites)
Culture / Bronchial Culture (includes gram stain and reflexes to identification and sensitivity if appropriate)
Body Fluid Culture (includes gram stain and reflexes to identification and sensitivity if appropriate)
CSF Fluid Culture (includes gram stain and reflexes to identification and sensitivity if appropriate)
Ear/Eye Cultures (includes gram stain and reflexes to identification and sensitivity if appropriate)
Nose/Throat Culture (reflexes to identification and sensitivity if appropriate)
Sputum Culture (includes gram stain and reflexes to identification and sensitivity if appropriate)
Stool Culture (reflexes to identification and sensitivity if appropriate)
Tissue Culture (includes gram stain and reflexes to identification and sensitivity if appropriate)
Urine Culture (reflexes to identification and sensitivity if appropriate)
Wound Culture (includes gram stain and reflexes to identification and sensitivity if appropriate)
Fungus Culture (includes KOH)
AFB Culture (Includes AFB stain on In patients)
Bedside Glucose / Bedside Glucose (reflexes to glucose confirmation by laboratory if appropriate)
Be sure to allow a space for physician to hand write “Other Orders.”
J. Elton Turbes, Laboratory Administrative Director. 2/22/10 updated 4/2/10, 5/21/10, SpBachinski 8 10 12

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