plk-price-catalogue-2022

SPECIMEN LABELING
& Completion of Request Forms
Specimen labels
The specimen tubes or container should each be
labelled with the patient’s name as it appears on
the request form submitted with the specimen. The
date of collection and gender should also be
included. The label should be legible. If affixed,
ensure it is securely attached. If handwritten, use
black or blue inked pen. For microbiology and
histology/cytology specimens indicate the site from
which the specimen was obtained (e.g. pleural fluid,
breast, etc).
Aliquot / Transferred specimen
If the specimen is an aliquot transferred to a nonprimary
tube, please indicate the specimen type (e.g.
serum, plasma or urine).
Request form completion
The request form should be comprehensively filled. If
submitting with a Pathologists Lancet Kenya request
form, ensure that all the sections are duly completed.
Pathologists Lancet Kenya request forms can be
obtained from the lab through our Customer Service
Team.
Minimum information required includes:
• Patient unique identifiers such as name,
reference, ID and telephone number.
• Patient demographic details including
gender, date of birth and address.
• Details of the requesting doctor.
• Tests to be done.
• Date, time and source of sample collection.
• Relevant clinical information.
New generation request forms
As part of our continued effort to meet client
expectations, we have introduced a wide range of
new generation request forms that are customised
for different users and specialties.
The request forms include:
• General problem form for GPs
• Specialist forms for Gynaecologists,
Surgeons, Paediatricians, Oncologists,
Urologists, Dermatologists and other specialists
• We also have retained our traditional universal
form which has been made less congested but
still bears a wide tests scope.
• Research clients and dedicated client clinics are
able to order custom-made forms specific to
their test profiles.
• To get a new generation or customised form,
contact customerservice info@lancet.co.ke
Referring
Doctor
Patient Details
Paent ID no
Paent surname
Paent inials & first name
Paent Date Of Birth
Hospital /folio number
Naonality
Paent Cell No
Paent Email
Department
Work Staon
Telephone / Fax Number
UNIVERSAL REQUEST FORM
Copy
Doctor
Collecon Date Time HOUR MIN
Veneseconist
D D M M Y Y Y Y Gender F M
Age
Submied
Person Responsible For Payment of Account
Surname & Inials
First Name
Postal Address
Telephone No ©
Patient/guardian signatures :
my signatures indicates my understanding of and my agreement to comply with the terms of the legal declaraon ,provide consent for the
processing of personal informaon and the releasing of tests results as documented on the back of this form. I give consent for tests results as
documented on the back of this form, I give consent for tests and guarantee payment of any amounts .
ICD 10 Codes:
Clinical Drug informaon
Other tests
Lung,Kidney,Skeleton
J169 B U&E/Creanine
K170 B Urea& Creanine
M402
Creanine Clearance
A161 B Potassium
F166 B Sodium
S130 B Calcium
D394 B Phosphate
X158 B Magnesium (serum)
K228 E Magnesium (RBC)
L171 B Uric acid
U247
Protein 24hr Urine
H685 U Protein /creanine rao
G121 B Alpha -1 Antrypsin
A115 B ACE
Glucose Metabolism
G144 FL Glucose- Fasng
H145 FL Glucose-random
T407 FL GTT 2hr 75g – standard
L148 E HBA1C/GlycosyLDL- lated Hb
K958 U Microalbunim -urine
Lipid Metabolism
W134 B Lipogram
F9 B Cholesterol only
F9 B Cholesterol /HDL
K492 B LDL -measured
G167 B Triglycerides
Follow us on
Pathologists Lancet Kenya -PLK
@lancetkenya_plk
www.cerbalancetafrica.ke
I.D NO
Email
Employer
Medical Aid Name
Med Aid #cash receipt
Authorisaon#
Dependent code
Paent Membership
Card
ACC NO
Heart and Muscle
F9 BH Chest pain profile
H168 BH Troponin
V142 BH CK
F9 BH CKMB
K400 BH Myoglobin
P129 E homocysteine (fasng )(on ice)
X284 B Ultrasensive CRP
W354 B Pro BNP
Liver/Pancreas /GIT
T158 B LFT – Full Profile
L125 B Billrubin-total=conj
K126 B Billrubin-neonatal (SBR)
E119 B Alkaline phosphate
K124 B Amylase
F232 B ALT
B234 B AST
F143 B Gamma GT
V156 B LDH
F143 FL Lactate-on ice
D118 B Aldolase
Bone Turn over
R778 C B C-terminal crosslinks fasng
E120 B Bone specific alk.phos
G400 B Osteocalcin -on ice
X227
Parathrome
R994 B Vitamin D
Switchboard Numbers
+254 703 061 000
+254 729 110 110
+254 736 493 100
Copy
Doctor
Paent MRI#
Autoimmune
N334 B Rheumatoid factor
W593 B An CCP
A996 B ANA includes paern
H584 dsDNA -specific
G282 B c-ANCA/p-ANCA
W476 B Auto -immune hepas
(SM AB, LKM -1,SLA)
C821 B Coeliac disease
Z424 B HLA B27
Z424 B CTD screen
Allergy
C256 B Total igE
B254 B Aero-allergen screen
(Phadiatop)
N357 E White cell count + Diff
Coagulation
F373 B An-phospholipid Ab
D881 HC D-Dimer -quantave
Z367
DIC screen
C393 C Fibronogen
BOOK
Limited bleeder screen
K325
Lupus inhibitor
B369 C PI/INR
F402 C PI/INR dosage
C370 C PTT
BOOK
Thrombosis -arterial
T968
Thrombosis scr- venous
Cerba Lancet
Africa
Hepatitis Viruses
E303
G385
H306
H749
C301
W487
K561
G305
E395
P140
HAV Igm
HAV IgG
HBV immunity (sab)
Hepas B&C
Hepas A,B,C
HBV qualitave PCR
HBV qualitave PCR
HCV Ab
HCV qualitave PCR
HCV Viral Load
Other Infectious Diseases
K861
Adenovirus PCR
A617
Atypical pneumonia PCR
W345
Bordetella PCR
X 296
CMV Ab
C756
CMV qualitave PCR
G914
CMV Viral load PCR
U293
Coxsackie Ab
Y297
EBV Ab
Q427
EBV Viral load PCR
X504
Genital discharge scr
E852
B300
A189
M730
S3337
R169
Y343
Genital ulcer screen
H. Pylori Ab
Influenza PCR
Malaria species genotyping PCR
Rubella Ab
RSV PCR
Syphillis serology
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