RITM Training Manual for

Specimen
Collection, Transport
and Referral during
Infectious Disease
Outbreak Response

MODULE 5. THE LABORATORY REFERRAL SYSTEM

RITM Training Manual for Specimen Collection, Transport and Referral during
Infectious Disease Outbreak Response
 Learning Objectives
At the end of the presentation, the participants will understand
1. Objectives of an efficient laboratory referral system
2. Roles and responsibilities of laboratories by level of service
capabilities
3. The Laboratory Referral Network
4. Laboratory Referral Flow
5. Requirements for Specimen Referral
6. Rejection of outbreak Specimens
Session 1: Objectives of an Efficient
Laboratory Referral System
 Introduction
• A laboratory referral system will ease and optimize the work-flow
when an investigation is underway, saving time while providing the
best-quality testing available.

• Knowing which laboratory to send specimens to and what tests

these laboratories can perform is important in the decision-making
process before an investigation into a reported disease outbreak
begins.
Objectives of an efficient laboratory
referral system
1. To ensure that specimens are received and processed
immediately in the appropriate laboratory for surveillance and
outbreak support for a given type of specimen and the tests it
requires;
2. To standardize the procedures of specimen collection, handling
and transport;
3. To standardize the flow of information from specimen collection
to release of results;
4. To prevent the loss of vital laboratory information due to loss,
rejection or mishandling of specimens;
Objectives of an efficient laboratory
referral system
5. To ensure that operations are documented and the samples are
identifiable and traceable at every step of the process;
6. To ensure safety of field investigators and laboratory health
workers during receipt, handling and processing of outbreak
sample
7. To ensure security of the samples and isolates from intentional
misuse;
8. To comply with local and international standards for quality
assurance of laboratory results
 Session 2: Roles & Responsibilities
of Lab by Level of Service Capability
Laboratory Situation in the Philippines
• Not all laboratory tests are available at every facility or at every level of
the health system.
• Cultures for identification and confirmation of bacteria may be available
in some tertiary hospitals/facilities
• Viral confirmatory test (viral culture, neutralization tests, PCR) are
currently available only at RITM
• Under the Philippine Integrated Disease Surveillance and Response
(PIDSR) system, the Regional Epidemiology Surveillance Units (RESUs)
are responsible for identifying and coordinating laboratories within their
regions which can perform testing of outbreak samples from the cities,
provinces and municipalities that refer cases (PIDSR Manual of
Procedures 3rd edition, Volume 1, Section 3.6).
(http://www.doh.gov.ph/node/9985)
 INFORMATION SHARING

INFORMATION SHARING

INFORMATION SHARING
GLOBAL
SPECIALIZED
LABORATORY
REGIONAL
REFERENCE
LABORATORY

NATIONAL REFERENCE
LABORATORY

SUB-NATIONAL
LABORATORY

REGIONAL
LABORATORY

TERTIARY LABORATORY

PERIPHERAL LABORATORY (REFERRING

INSTITUTION/DRU)

INFORMATION SHARING

Laboratories by level of service capability and their relationship with each other in term of
referral of specimen and sharing of information, capacity and technical expertise.
Roles and Responsibilities of
Laboratories at Different levels
CLASSIFICATION OF CLINICAL LABORATORIES
BY SERVICE CAPABILITIES
• PRIMARY CATEGORY – provide minimum service capabilities:
Routine Hematology (Complete Blood Count, Qualitative Platelet Determination,
Routine Urinalysis, Routine Fecalysis and Blood Typing for hospital-based)

• SECONDARY CATEGORY - provide minimum service capabilities of a primary

category laboratory plus the following:
Routine Clinical Chemistry, Quantitative Platelet Determination, Cross matching for
hospital based, Gram Staining- for hospital based, KOH for hospital based

• TERTIARY CATEGORY - provide minimum service capabilities of a secondary category

laboratory plus the following:
Immunology, Special Chemistry, Special Hematology including coagulation procedures,
Microbiology- culture and susceptibility test: aerobic and anaerobic (for hospital based
and non-hospital based)
PERIPHERAL LABORATORY
• Laboratories at the level of the referring institution or DRU

• Collect clinical specimen for testing

• Performs preliminary routine testing on clinical specimen

(if appropriate)

• Refers clinical specimen to the nearest capable tertiary, regional

laboratories or SNL or to the NRL if the tests are only available
at the NRL
QUALIFIED TERTIARY LABORATORY*
• City or Provincial Laboratories with tertiary level capability
(i.e., able to do routine clinical laboratory microbiologic testing)
Collects and receives clinical specimen for testing
 Performs culture and susceptibility tests for aerobic bacterial outbreak pathogens

• Performs preliminary tests for pathogens requiring specialized tests(if capable)

• Refers clinical specimens to Regional laboratories or SNL for confirmatory testing

if unable to perform testing or to the NRL if the tests are only available at the NRL

• Submits positive bacterial isolates to NRLs for confirmatory testing, isolate banking and
epidemic strain assessment

• Participation in external quality assessment programs provided by NRLs

• Provides technical assistance to peripheral laboratories

• Provides EB with timely and quality-assured results of tested specimens

• Regularly reports summary of data to EB and relevant NRL

QUALIFIED REGIONAL LABORATORY*
• Regional laboratories with tertiary level capability
(i.e., able to do routine clinical laboratory Microbiologic testing)
Collects and receives clinical specimen for testing
 Performs culture and sensitivity tests for aerobic bacterial outbreak pathogens
• Performs preliminary tests for pathogens requiring specialized tests (if available)

• Refers clinical specimens to NRLs for confirmatory testing if unable to perform testing or
if the test are only available at the NRL

• Submits positive bacterial isolates to NRLs for confirmatory testing, isolate banking and epidemic strain
assessment

• Participants are external quality assessment programs provided by NRLs

• Provides technical assistance to tertiary and peripheral laboratories

• Provides transport media to tertiary and peripheral laboratories

• Provides EB with timely and quality assured results of tested specimens

• Regularly reports summary of data to EB and relevant NRL

SUB-NATIONAL LABORATORY (SNL)***
• Five (5) designated and capacitated tertiary laboratories which assist RITM during outbreaks
in the timely detection and confirmation of emerging/re-emerging infections for which they are
qualified and trained

• Collects and receives clinical specimen for testing

• Performs Real-time RT-PCR for emerging-re emerging infections during outbreaks

• Refers positive, untypable and negative specimens to NRL for confirmatory testing

• Submits positive samples, untypables and proportion of negative samples to NRLs

for re-testing, storage and further studies

• Participates in external quality assessment programs provided by NRLs

• Provides technical assistance to regional, tertiary and peripheral laboratories

• Provides transport media to regional, tertiary & peripheral laboratories

• Provides EB with timely and quality-assured results of tested specimens

NATIONAL REFERENCE LABORATORY (NRL)
• Performs laboratory diagnosis for outbreak specimen if there is no capable tertiary or sub-
national reference laboratory near the site of outbreak

• Receives clinical specimens/isolates for testing

• Performs specialized diagnostic test (e.g. Anthrax, atypical bacteria, leptospirosis, viruses,
emerging infections, newly identified pathogens)

• Provides confirmatory tests to tertiary, regional and sub-national laboratories

• Provides peripheral/referring laboratories with transport media as well as guidelines on

preparation and use of such media

• Banks positive outbreak isolates nationwide (NRL as central repository of isolates nationwide)

• Assesses epidemic strains by characterizing isolates genetically or phenotypically

(if applicable)
NATIONAL REFERENCE LABORATORY (NRL)
• Sets guidelines for laboratory testing

• Informs other laboratories of updates or alerts

• Provides technical assistance to other laboratories

• Trains staff from other laboratories for specimen collection and testing

• Provides quality assessment to laboratories

• Informs EB, NCHFD and other stakeholders of the capability of tertiary and sub-
national reference laboratories to perform specific tests

• Provides EB with timely and quality-assured results

REGIONAL REFERENCE LABORATORY /
GLOBAL SPECIALIZEDLABORATORY (RRL/GSL)
• Reference laboratories at the Regional/Global level which provide technical assistance
and support to countries under the WHO network

• Receives clinical specimens/isolates for testing

• Performs specialized diagnostic tests and characterization of isolates

• Assesses epidemic strains by characterizing isolates genetically or phenotypically

• Provides technical assistance to NRLs

• Provides training

• Provides quality assessment to NRLs

• Provides NRLs with timely and quality assured results which shall shared to EB
Session 3: Laboratory Referral Network
Network of Laboratory Referral System
• Peripheral Laboratory
• Qualified Tertiary Laboratory *
• Qualified Regional Laboratory **
• Qualified Sub-National Laboratory ***
• National Reference Laboratory
• International Collaborating Centers and Referral Laboratories/
Regional Reference or Global Specialized Laboratories
(RRL/GSL)****
* - based on their performance in the NEQAS for Bacteriology( score of 80% and above)
** - based on their performance in the NEQAS for Bacteriology ( score of 80% and above)
*** - SNL for Pandemic Influenza A/H1N1 PCR , should pass the annual proficiency test (EQAS,NEQAS provided by RITM and
another quality assurance checks by the National Reference Laboratory)
**** - laboratories that receive and test specimens from countries in a WHO region who are part of the international lab. network
( i.e. Philippines belong to the Western Pacific Region for polio, measles, influenzae) for further specialized testing.
LIST OF QUALIFIED TERTIARY GOVERNMENT LABORATORIES
REGION NAME OF HOSPITAL CONTACT DETAILS REMARKS
1 La Union Medical Center* 72-7101698 Microbiology Laboratory
1 Ilocos Sur Provincial Hospital Gabriela Silang* 077-7228031 Microbiology Laboratory
1 Mariano Marcos Memorial Hospital & Medical Center* 77-7923144/7923133 Microbiology Laboratory
1 72-8883671/72- Microbiology Laboratory
Ilocos Training and Regional Medical Center 2421143
1 Region 1 Medical Center** 75-5158916/5153815 Microbiology Laboratory
2 Veterans Regional Hospital** 3212090/3213560/ Microbiology Laboratory
Fax: 8051310
3 Tarlac Provincial Hospital* 045-9820806 Microbiology Laboratory
3 Jose B. Lingad Memorial Regional Hospital** 045-9612808 Microbiology Laboratory
4 General Emilio Aguinaldo Memorial Hospital* (046) 419-0123 Microbiology Laboratory
5 Bicol Medical Center* 054-4725041 Microbiology Laboratory
5 Bicol Regional Training and Teaching Hospital** 052-4830014 Microbiology Laboratory
6 West Visayas State University Medical Center* (033) 320-0870/ 320- Microbiology Laboratory
2431
6 Corazon Locsin Montelibano Memorial Regional Hospital** (034) 435-1591/ 434- Microbiology Laboratory
6947
LIST OF QUALIFIED TERTIARY GOVERNMENT LABORATORIES

CONTACT
REGION NAME OF HOSPITAL REMARKS
DETAILS
6 Angel Salazar Memorial General Hospital - Clinical Laboratory* (036) 330-1830 Microbiology Laboratory
7 Gov. Celestino Gallares Memorial Med. Center** (038) 411-4831/ Microbiology Laboratory
411-3138/ 411-2350
8 Eastern Visayas Regional Medical Center** (053) 321-3129 Microbiology Laboratory
9 Zamboanga City Medical Center 9912934/9920052/992 Microbiology Laboratory
0154
10 Mayor Hilario A. Ramiro Sr. Regional Training And Teaching (088) 521-0022/ Microbiology Laboratory
Hospital** 521-0440
10 Misamis Occidental Provincial Hospital* (088) 531-1529/ Microbiology Laboratory
1042/531-1529
10 Northern Mindanao Medical Center ** (088) 227-21794 Microbiology Laboratory
11 Southern Philippines Medical Center* 082-2272731 Microbiology Laboratory
11 Davao Regional Hospital** 084-2173571 Microbiology Laboratory
12 Cotabato Regional and Medical Center-Clinical Laboratory** 064-4212192 Microbiology Laboratory
13 Caraga Regional Hospital Laboratory** (086) 826-2459/ Microbiology Laboratory
826-3157/ 826-1748
LIST OF QUALIFIED TERTIARY GOVERNMENT LABORATORIES

REGION: NAME OF HOSPITAL CONTACT DETAILS REMARKS

NCR Dr. Jose Fabella Memorial Hospital* 7357144 Microbiology Laboratory
Fax: 3146016/7357146
East Avenue Medical Center* 9280611/9292031 Microbiology Laboratory
Jose R. Reyes Memorial Medical Center* 7119491 Fax: 7321629 Microbiology Laboratory
Justice Jose Abad Santos Hospital* 3105342 Microbiology Laboratory
Las Piñas General Hospital & Satellite Trauma 8720509 Loc. 122 Microbiology Laboratory
Center - Laboratory*
National Kidney & Transplant Institute- 9810300 Microbiology Laboratory
Department of Laboratory Medicine* loc. 1048

National Center for Mental Health* 5319001/5343241/5319004 Microbiology Laboratory

loc. 4401
Fax: 5318682
National Children’s Hospital* 7236932 Microbiology Laboratory
Ospital ng Makati* 8826316 loc. 358 Microbiology Laboratory
Ospital ng Maynila Medical Center* 5237576 Microbiology Laboratory
Pasay City General Hospital* 8334314 Microbiology Laboratory
LIST OF QUALIFIED TERTIARY GOVERNMENT LABORATORIES

REGION: NAME OF HOSPITAL CONTACT REMARKS

PERSON
NCR Pasig City General Hospital* 6427381 Microbiology Laboratory
Philippine Children's Medical Center* 9246601-25/9240887 Microbiology Laboratory
Philippine Heart Center, Division of Laboratory 9252401 loc. 5122 Microbiology Laboratory
Medicine*
Philippine General Hospital* 5848400 loc. 3206 Microbiology Laboratory
San Lazaro Hospital, Department of Laboratories* 7323777/ 7116966/ Microbiology Laboratory
3099552
Sta. Ana Hospital* 5166151 Microbiology Laboratory
San Juan Medical Center* 7259804 / 7259948 Fax: Microbiology Laboratory
7253765
Valenzuela Medical Center* 2946711-14 / Microbiology Laboratory
2946717/2914259
Veterans Memorial Medical Center* 9276426 loc. 2591 Microbiology Laboratory
LIST OF QUALIFIED SUBNATIONAL/GOVERNMENT LABORATORIES
REGION NAME OF HOSPITAL CONTACT DETAILS REMARKS
NCR Lung Center of the Philippines Subnational Laboratory for
9246101 to 20
Influenza/Microbiology
Fax: 9246101 loc. 251
Laboratory
NCR San Lazaro Hospital Subnational Laboratory for
7323776/ 7114117 Influenza/Microbiology
Laboratory
7 Vicente Sotto Memorial Medical Center Subnational Laboratory for
032-2539891 Influenza/Microbiology
Laboratory
11 Southern Philippines Medical Center Subnational Laboratory for
082-2272731
Influenza/Microbiology
loc. 4508
Laboratory
CAR Baguio General Hospital & Medical Center Subnational Laboratory for
(074) 442-4216
Influenza/Microbiology
loc. 219/212
Laboratory
LIST OF NATIONAL REFERENCE LABORATORIES IN RITM
DEPARTMENT NATIONAL REFERENCE LABORATORY CONTACT PERSON CONTACT NUMBER
MICROBIOLOGY EMERGING & RE-EMERGING DISEASES DR. MARIA ROSARIO Z. 8072628 TO 31/32/37
CAPEDING LOCAL 604, 8501949
BACTERIAL ENTERIC DISEASES
MYCOLOGY
INVASIVE BACTERIAL VACCINE
PREVENTABLE DISEASE (NATIONAL
LABORATORY
VIROLOGY MEASLES AND OTHER VIRAL EXANTHEMS DR. AMADO O. TANDOC III 8072628 TO 31/32/37
LOCAL 605, 8097120
INFLUENZA
DENGUE
POLIO
ROTAVIRUS (NATIONAL LABORATORY)

PARASITOLOGY MALARIA AND OTHER PARASITES DR. FE ESPERANZA J. 8072628 TO 31/32/37

ESPINO LOCAL 227
UNKNOWN ETIOLOGY SURVEILLANCE UNIT MS. ROWENA CAPISTRANO 9941887
Session 4: Laboratory Referral Flow
LAB REFERRAL FLOW AND STEPS
• Relies on a coordinated series of activities in which the samples are
properly collected, handled, and documented prior to shipping,
identifiable and traceable. This prevents loss, misidentification, and
other potential problems, that can affect the integrity of the
outbreak investigation

STEP 1:
• The referring institution/DRU/CESU/PESU/MESU informs the RESU of the
outbreak and collects the specimen according to the guidelines outlined in the
manual
LAB REFERRAL FLOW AND STEPS
STEP 2:
• The RESU shall inform EB regarding the outbreak and also provide technical
assistance to the referring institution. RESU s shall identify the testing
laboratory to which the specimen shall be referred according to their list of
laboratories within the region.
• RESU contact the testing laboratory to inquire the availability of the test and
their operating hours
• If the testing laboratory agrees to the referral, the RESU shall inform the
referring institution/ESU where and how to refer the specimen
• If the local or regional laboratory is unable to do the test, RESU should inform
the RITM- Surveillance Unit immediately
LAB REFERRAL FLOW AND STEPS
STEP 3:
• The referring institution/ESU shall ship the specimen with the required
documents to the selected laboratory according to the guidelines in the
manual
LAB REFERRAL FLOW AND STEPS
STEP 4:
• The referring institution/ESU shall notify RESU, EB and the laboratory that agreed to do the testing
of the shipment, by phone and FAX or email, with the following details:
 Referring institution/ESU
 Requesting physician/health worker
 Outbreak details: Number of cases, location
 Suspected pathogen
 Test requested
 Purpose (i.e. confirmatory testing for outbreak investigation
 Specimen type and total number sent
 Expected date of arrival in testing laboratory
 Courier (if applicable) including tracking number
 Shipper’s name, signature, position , institution/agency and contact information

• If sample is sent to RITM, the shipper should address to Rowena Capistrano, Surveillance &
Response Unit, RITM, Alabang, Muntinlupa City
LAB REFERRAL FLOW AND STEPS
STEP 5:
• The referring institution/ESU shall ensure that the testing laboratory
acknowledge the shipment by phone

STEP 6:
• Upon receipt of shipment, the testing laboratory shall check that the number
and type of specimens conform with the information/notification provided by
the sending institution. The specimen type and quality should be in
accordance with the guidelines specified in the manual. The testing laboratory
shall also ensure that all the received specimens have corresponding required
documents
LAB REFERRAL FLOW AND STEPS
STEP 7:
• If there are discrepancies or if a specimen is rejected, the testing laboratory
shall immediately inform the referring institution/ESU for appropriate action

STEP 8:
• The testing laboratory shall perform the test, validate and issue official results
to the RESU and EB within the prescribed turn-around times

STEP 9:
• The RESU shall give the result to referring institution
The figures below illustrate the network, level of service capability and their relationships
with each other in terms of referral of specimen and sharing of information, capacity and
technical expertise
Suspected
Outbreak

REFERRING INSTITUTION (DRU/CESU/MESU)

• Informs RESU and advance information for RITM-SRU
• Investigates cases
• Collects Specimen
• Prepares Specimen and documents for shipment

RESU
• Informs EB of outbreak
• Provides technical assistance to referring institution or ESU
• Identifies testing laboratory based on the list of qualified laboratories provided
by NRLs and inquiries for the availability of the test and operation hours

REFERRING INSTITUTION (DRU/CESU/MESU)

• Packages and ships specimen to testing laboratory in accordance with the guidelines
• Notifies testing laboratory, RESU and EB of the shipment by phone or fax
•Notifies RITM-SRU and send details of specimen shipment
•Ensures that the testing laboratory acknowledge the shipment

NATIONAL REFERENCE LABORATORY (RITM)

• Checks that type and number of specimens conforms with the notification
• Ensures that all received specimens have corresponding required documents
• Verifies that specimen type and quality are in accordance with the guidelines
Flow of Referral of Specimen from Outbreak
Investigation
Outbreak
specimen

Does the regional

Yes laboratory had the No
capacity to test the
specimen?

Send specimen
to Regional Does the sub-
laboratory Yes national laboratory No
had the capacity to
test the specimen?

Regional laboratory Send specimen Send specimen to

proceed to process to Regional RITM National
the specimen laboratory Reference
laboratories

Sub-national
laboratory proceed Clinical laboratory
to process the receive and forward the
specimen specimen to the their
respective NRLs

NRLs proceed to
process the specimen
SRU Flow of Releasing of Results (A)
Laboratory Result of Low Profile Outbreak
Testing Laboratory
releases low profile
outbreak results

Hard copy of line list and

individual result shall be
forwarded to RITM-SRU

Copy of result shall be

sent to respective RESU
or DRU

Laboratory
Coordinator/Surveillance
Nurse duty on the clinical
laboratory shall sends results
to DRU
SRU Flow of Releasing of Results (B)
Laboratory Result of High Profile Outbreak
Testing Laboratory
releases high profile
outbreak results

Succeeding
1st Case cases

Results Non-paying Paying

forwarded to DO

Result shall be
RITM-SRU sends forwarded to
the results to the RITM-SRU
RESU or DRU
RITM-SRU copy
of result to EB,
Clinical laboratory releases RESU and DRU
result to requisitioner and
gives duplicate copy to
RITM-SRU Results forwarded to
Clinical Laboratory
Session 4B: Selecting the Laboratory
for SpecimenTesting
 How to select a laboratory
1. RESU staff to map Regional Lab Network existing in the area
before any outbreak
2. If mapping is not done prior, then find out available local and
referral laboratories near the area where the suspected outbreak
is being investigated and their access to the site and transport
possibilities.
3. Consult the laboratory concerned. The lab may have to supply
special media, equipment, and specimen collection and transport
instructions in advance. Consider:
bio safety level, geography, timelines
Identify and activate the laboratory network
Session 5: Checklists for Specimen Referral
Requirements for Specimen Referral
Proper specimen referral is essential to obtaining accurate
laboratory diagnosis of infectious diseases. There are three (3) sets of
checklist of requirements that should be complied with to ensure
proper specimen referral as follows:

1: SPECIMEN REQUIREMENTS
2: DOCUMENT REQUIREMENTS
3: COMMUNICATION/COORDINATION REQUIREMENTS
1: SPECIMEN REQUIREMENTS
PROPER SPECIMEN COLLECTION: Adherence to the following requirements for specimen collection ensures
accurate laboratory diagnosis
SPECIMEN TYPE & DATE OF COLLECTION The specimen should be representative of the
infectious process and suitable for the test method
to be used. It is important to collect the correct type
at the appropriate phase of diseases (e.g. acute or
convalescent)

SPECIMEN COLLECTION SAFETY • Strict aseptic techniques in collection

• Hand washing before and after collection
• Appropriate PPE worn during collection as
appropriate
• Appropriate decontamination and disposal of
potentially infectious wastes and materials

SPECIMEN QUALITY • Ideally the specimen should be freshly and

aseptically collected
• Specimen should be collected before
administration of antimicrobial agents
• The specimen must be in the appropriate
transport media
1: SPECIMEN REQUIREMENTS
SPECIMEN QUANTITY • Of the optimal amount as specified per target
organism
SPECIMEN CONTAINER • Specimen container must be clean, sterile and
leak-proof
• The outside of the specimen container should be
cleaned and decontaminated prior to packaging
SPECIMEN STORAGE • The temperature inside the specimen container
depends on the type of test that will be
performed and the sensitivity of the organisms to
extreme temperature
• If the type of test requires a viable organism in
the specimen, then the temperature during
storage should be ideal for the growth of the
organism
• Appropriate transport media should be used if a
viable organism in the specimen is required by
the test procedure
PROPER SPECIMEN PACKAGING: The following requirements for specimen packaging ensure safe practices and
decrease the likelihood of contamination, breakage/leakage in transit and misidentification of samples
SPECIMEN LABEL • The specimen should be properly labelled with the
following information
 Specimen ID/patient name
 Age/Sex
 Specimen type
 Date and time of collection
PACKAGING • For infectious substances, the specimen should have three
(3) components for packaging of specimen: primary,
secondary receptacles and rigid outer packaging
• Parcels should be properly labeled with:
 Correct shipper’s (sender) address
 Correct consignee’s (i.e. receiver) address
 Emergency contact information (name & contact
number
 Biosafety levels (i.e. biosafety stickers, IATA-specified
labels such as “Biological Substance, Category B
 Orientation arrows placed on two (2) opposite sides of
the package
 Net weight or volume of sample if multiple packages
are being sent
Session 5: Rejection of Outbreak Specimens
Criteria for Rejection
• The criteria encompass non-compliance with the three
requirements
1: SPECIMEN QUALITY (NON-COMPLIANCE WITH
SPECIMEN REQUIREMENTS
2: SPECIMEN INFORMATION (NON-COMPLIANCE WITH
DOCUMENT REQUIREMENTS)
3: SPECIMEN COORDINATION (NON-COMPLIANCE WITH
COMMUNICATION/COORDINATIONRQUIREMENTS)
Criteria for Rejection
1. SPECIMEN QUALITY
• Inappropriate specimen type for the requested test
• Insufficient quantity
• Leaking/broken container
• Suspicion of contamination or tampering
• Inappropriate transport or storage
• Unknown time delay
• Sample deterioration e.g. hemolysis for serologic samples; bacterial
overgrowth or contamination)
• Unlabeled or illegibly labeled specimen
Criteria for Rejection
2. SPECIMEN INFORMATION
• Incomplete documents
• Missing information in documents

3: SPECIMEN TRANSPORT AND REFERRAL COORDINATION

• Testing laboratory is not notified of the shipment
• There is no documented acknowledgement by the testing laboratory of
acceptance of the specimen