SP Brand Urine hCG Test
Instructions: Please complete the information below. Be sure to select your group on the left below (CBC, RMCHP, or FP if OUTPATIENT, OR a Service if INPATIENT / HOSPITAL). In addition, select the corresponding clinic or hospital service (drop down menu). AGENCY: Please use last 6 digits of social security number for Employee ID. Employee Information Emp ID First Last UTMB Clinics -------------------------------- (select site) ------------- PCP--------------- ANTICOAG FAM MED GERIATRICS GALV PEDI INTERNAL MED OB SUITE 111 PCP PEDI STARK DIAB CENTER STEWART RD FAM H URGENT CARE -------------UHC-------- (select site) CHRONIC HOME DIALYSIS DERM EMP HEALTH GI OBGYN/ DYSPLASIA NEUROSURG NST/ULTRASOUND OB-GYN RAD/ ONCOLOGY RENAL UROLOGY UROL/CLEFT PALATE ----------REB SEALY-------- (select site) DAY SUR BEHAV HEALTH RES ID-VIROL ORTHO -------OTHER ---------- CBC -------------------------------- (select site) ALVIN AUSTIN W C FRWD FAM H FRIENDSWOOD PEDI GALV FH LEAGUE CITY TX CITY HC TX CITY PEDI other RMCHP -------------------------------- (select site) *ADMINISTRATIVE* ANGLETON BEAUMONT BIRTH CENTER CONROE DICKINSON GALVESTON PCP HUNSTVILLE KATY LIVINGSTON MCALLEN NACGADOCHES NEW CANEY ORANGE PASADENA PEARLAND PRAIRE VIEW STAFFORD TEXAS CITY VICTORIA WHARTON other Hospital Service -------------------------------- (select site) Agency AMB CARE ------------------------------------------ CRITICAL CARE CLUSTER ------------------------------------------ SICUA (J2A) SICUB (J2B) BBU (J2D) MICU (J4A) CCU (J4B) ECMO TELEMETRY (J7A/B/C) CTCU (J7D) ------------------------------------------ MEDICAL SURG CLUSTER -- ------------------------------------------ INF THPY (J2C) GEN MED J5C/D SURGERY(J6A) RENAL TRANSPLANT (J6B) NEUROSURG (J6D) HEMODIALYSIS (J8B) GYN/ONC (J9A) ------------------------------------------ WOMEN'S CLUSTER ------------------------------------------ L&D ANTEPARTUM (J3A) WS P4 WS P5 OBGYN (J3A/B) ------------------------------------------ INFANTS/ PEDI CLUSTER ------------------------------------------ ISCU N NSY (WSP2) NEO TRNASPORT WS P3 (BIRTH CENTER) C4N (PICU) C5N (CECU-REHAB) C4S (GEN PED, HEM/ONC) C5S (GEN PED, HEME/ONC) C6S (GCRC) C6N (HEMODIALYSIS) ------------------------------------------ PERIOPERATIVE CLUSTER-- ------------------------------------------ DAY SUR PACU OR ------------------------------------------ EMERGENCY SERVICES-- ------------------------------------------ TDCJ CLUSTER-- ------------------------------------------ TDCJ 3A TDCJ 3B TDCJ 4 TDCJ 6A TDCJ 6B TDCJ 6C TDCJ 7A other----------------------------------- GCRC ------------------------------------------ DEPARTMENTS ------------------------------------------ INTERNAL MEDICINE PULMONARY DERMATOLOGY ANESTHESIA ENT Date: Month JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Year 2012 2013 2014 1. In cases of early pregnancy, a NEGATIVE pregnancy result may be obtained. In such cases, it is recommended a sample is re-tested after 48 hours, or in cases where patient will be undergoing critical medical procedures. TRUE FALSE 2. The SP Brand urine pregnancy test requires documentation of internal QC after each patient test. Documentation can be done either on paper log or electronically. True False 3. When performing a URINE pregnancy test using the SP Brand, test must be read at 3 minutes. True False 4. When stored at room temperature, kits are good ____________ . until the expiration date on the BOX for 1 year for 6 months for 1 month 5. When performing a URINE pregnancy test using the SP Brand urine hCG cassette, you must add _______ to sample well. The kit must be laying on a flat surface for the 3 minutes period. 4 drops 3 drops 5 drops entire contents of pipette barrel area 6. TheSP Brand kit is sensitive to 25 IU/ml and above; therefore, negative pregnancy tests do not rule out pregnancy and are not considered definitive. TRUE FALSE
1. In cases of early pregnancy, a NEGATIVE pregnancy result may be obtained. In such cases, it is recommended a sample is re-tested after 48 hours, or in cases where patient will be undergoing critical medical procedures.
TRUE FALSE
2. The SP Brand urine pregnancy test requires documentation of internal QC after each patient test. Documentation can be done either on paper log or electronically.
True False
3. When performing a URINE pregnancy test using the SP Brand, test must be read at 3 minutes.
4. When stored at room temperature, kits are good ____________ .
until the expiration date on the BOX for 1 year for 6 months for 1 month
5. When performing a URINE pregnancy test using the SP Brand urine hCG cassette, you must add _______ to sample well. The kit must be laying on a flat surface for the 3 minutes period.
4 drops 3 drops 5 drops entire contents of pipette barrel area
6. TheSP Brand kit is sensitive to 25 IU/ml and above; therefore, negative pregnancy tests do not rule out pregnancy and are not considered definitive.
