(3)
Notes to physician.
(4)
Standard Form 558 (REV), Emergency Care Treatment.
(5)
Standard Form 541, Medical Record GYN Cytology.
(6)
DA Form 4137, Evidence/Property Custody Document (laboratory).
b. Labels. See table 7-1.
Quantity
Equipment for Specimen
Collection
1
Investigator--pubic hair combing
2 - small plastic bags
1
Investigator--head hair combing
1 - comb
2
Investigator sperm motility --yes/no (If
sperm found, use fixative, give to
investigator)
2
Investigator acid phosphatase tube
2 - red, screw-top test tube
lab slip stamped acid phosphatase
tube with cotton-tip swab
2
Investigator cytology smears (stain for
sperm) (ABO grouping)
1
Lab Pap smear (fixative in GYN room)
1 - plastic container with glass
slides
2
Investigator red-top blood tube lab
2 - red-top test tubes
slip HCG VDRL--circle one
1
Investigator secretion status
1 - saliva collection paper
1 - plastic bag
2
Investigator fingernail scrapings
2 - small, screw-top tubes
--left/right
1 - clippers
1 - wooden stick
1 - cotton-tip swab
1
Investigator or bag for clothing
1 - plastic bag
1 - patient's valuable checklist
1
HCG or UA lab slip
1 - plastic specimen cup
1
GC culture for N. gonorrhea
Table 7-1. Supplies.
c. Additional Equipment Added Prior to Examination.
(1)
One AGAR plate for GC culture--from refrigerator.
(2)
MD0586
7-5