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Laboratory Specimen Tracking Log

NC 1 8 3 0 1479 08 2022

Laboratory Medicine
Date: __________
DD/MONTH/YYYY Clinic or Agency Name: ___________________
Collector: ______________ External Collector Permit Number:______
Collector record number of specimens collected. Lab verify submission ( )
Time Time SST Serum Fluoride Citrate EDTA Urine Swab Other Lab
Patient Name and Gold Red Grey Lt. Blue Lavender Specify in
Collected Centrifuge Comments
Provincial Healthcare Number (If Applicable)
HH:MM
HH:MM
Number Number Number Number Number Number Number Number

10

LAB USE ONLY


Date and Time delivered to site Time Centrifuged Transport (Package)
DD/MONTH/YYYY HH:MM Staff Mnemonic (If Applicable - HH:MM) Refrigerated Room Temp Improper Package

Lab or Collector’s Comments:

1479 2022/11

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