Sync template from atomicqms-style deployment
This commit is contained in:
196
Forms/Specimen-Tracking/FRM-PATH-001-Specimen-Receipt-Log.md
Normal file
196
Forms/Specimen-Tracking/FRM-PATH-001-Specimen-Receipt-Log.md
Normal file
@@ -0,0 +1,196 @@
|
||||
# Specimen Receipt Log
|
||||
|
||||
| Form ID | FRM-PATH-001 | Revision | 1.0 |
|
||||
|---------|-------------|----------|-----|
|
||||
|
||||
---
|
||||
|
||||
## Log Information
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Date | |
|
||||
| Shift | ☐ Day ☐ Evening ☐ Night |
|
||||
| Accessioning Technician | |
|
||||
| Technician ID | |
|
||||
|
||||
---
|
||||
|
||||
## Specimen Receipt Record
|
||||
|
||||
### Specimen 1
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Time Received | |
|
||||
| Received From | ☐ OR ☐ Clinic ☐ Courier ☐ Transport ☐ Other: |
|
||||
| Accession Number | |
|
||||
| Patient Name | |
|
||||
| MRN | |
|
||||
| DOB | |
|
||||
| Specimen Type | |
|
||||
| Specimen Site | |
|
||||
| Number of Containers | |
|
||||
| Fixative | ☐ Formalin ☐ Fresh ☐ Other: |
|
||||
| Collection Date/Time | |
|
||||
| Container Labeled Correctly? | ☐ Yes ☐ No |
|
||||
| Requisition Complete? | ☐ Yes ☐ No |
|
||||
| Specimen Condition | ☐ Acceptable ☐ Compromised (see notes) |
|
||||
| Priority | ☐ Routine ☐ Rush ☐ STAT |
|
||||
| Discrepancy? | ☐ No ☐ Yes (Resolution: _______) |
|
||||
| Received By (Initials) | |
|
||||
|
||||
### Specimen 2
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Time Received | |
|
||||
| Received From | ☐ OR ☐ Clinic ☐ Courier ☐ Transport ☐ Other: |
|
||||
| Accession Number | |
|
||||
| Patient Name | |
|
||||
| MRN | |
|
||||
| DOB | |
|
||||
| Specimen Type | |
|
||||
| Specimen Site | |
|
||||
| Number of Containers | |
|
||||
| Fixative | ☐ Formalin ☐ Fresh ☐ Other: |
|
||||
| Collection Date/Time | |
|
||||
| Container Labeled Correctly? | ☐ Yes ☐ No |
|
||||
| Requisition Complete? | ☐ Yes ☐ No |
|
||||
| Specimen Condition | ☐ Acceptable ☐ Compromised (see notes) |
|
||||
| Priority | ☐ Routine ☐ Rush ☐ STAT |
|
||||
| Discrepancy? | ☐ No ☐ Yes (Resolution: _______) |
|
||||
| Received By (Initials) | |
|
||||
|
||||
### Specimen 3
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Time Received | |
|
||||
| Received From | ☐ OR ☐ Clinic ☐ Courier ☐ Transport ☐ Other: |
|
||||
| Accession Number | |
|
||||
| Patient Name | |
|
||||
| MRN | |
|
||||
| DOB | |
|
||||
| Specimen Type | |
|
||||
| Specimen Site | |
|
||||
| Number of Containers | |
|
||||
| Fixative | ☐ Formalin ☐ Fresh ☐ Other: |
|
||||
| Collection Date/Time | |
|
||||
| Container Labeled Correctly? | ☐ Yes ☐ No |
|
||||
| Requisition Complete? | ☐ Yes ☐ No |
|
||||
| Specimen Condition | ☐ Acceptable ☐ Compromised (see notes) |
|
||||
| Priority | ☐ Routine ☐ Rush ☐ STAT |
|
||||
| Discrepancy? | ☐ No ☐ Yes (Resolution: _______) |
|
||||
| Received By (Initials) | |
|
||||
|
||||
### Specimen 4
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Time Received | |
|
||||
| Received From | ☐ OR ☐ Clinic ☐ Courier ☐ Transport ☐ Other: |
|
||||
| Accession Number | |
|
||||
| Patient Name | |
|
||||
| MRN | |
|
||||
| DOB | |
|
||||
| Specimen Type | |
|
||||
| Specimen Site | |
|
||||
| Number of Containers | |
|
||||
| Fixative | ☐ Formalin ☐ Fresh ☐ Other: |
|
||||
| Collection Date/Time | |
|
||||
| Container Labeled Correctly? | ☐ Yes ☐ No |
|
||||
| Requisition Complete? | ☐ Yes ☐ No |
|
||||
| Specimen Condition | ☐ Acceptable ☐ Compromised (see notes) |
|
||||
| Priority | ☐ Routine ☐ Rush ☐ STAT |
|
||||
| Discrepancy? | ☐ No ☐ Yes (Resolution: _______) |
|
||||
| Received By (Initials) | |
|
||||
|
||||
### Specimen 5
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Time Received | |
|
||||
| Received From | ☐ OR ☐ Clinic ☐ Courier ☐ Transport ☐ Other: |
|
||||
| Accession Number | |
|
||||
| Patient Name | |
|
||||
| MRN | |
|
||||
| DOB | |
|
||||
| Specimen Type | |
|
||||
| Specimen Site | |
|
||||
| Number of Containers | |
|
||||
| Fixative | ☐ Formalin ☐ Fresh ☐ Other: |
|
||||
| Collection Date/Time | |
|
||||
| Container Labeled Correctly? | ☐ Yes ☐ No |
|
||||
| Requisition Complete? | ☐ Yes ☐ No |
|
||||
| Specimen Condition | ☐ Acceptable ☐ Compromised (see notes) |
|
||||
| Priority | ☐ Routine ☐ Rush ☐ STAT |
|
||||
| Discrepancy? | ☐ No ☐ Yes (Resolution: _______) |
|
||||
| Received By (Initials) | |
|
||||
|
||||
---
|
||||
|
||||
## Special Handling/Fresh Specimens
|
||||
|
||||
*Document any specimens requiring immediate processing (frozen sections, special studies, etc.)*
|
||||
|
||||
| Accession # | Specimen Type | Special Handling Required | Time to Grossing | Pathologist Notified |
|
||||
|-------------|---------------|---------------------------|------------------|---------------------|
|
||||
| | | | | ☐ Yes |
|
||||
| | | | | ☐ Yes |
|
||||
|
||||
---
|
||||
|
||||
## Discrepancy Log
|
||||
|
||||
| Time | Accession # | Discrepancy Type | Description | Resolution | Resolved By |
|
||||
|------|-------------|------------------|-------------|------------|-------------|
|
||||
| | | ☐ Labeling ☐ Requisition ☐ Condition ☐ Other | | | |
|
||||
| | | ☐ Labeling ☐ Requisition ☐ Condition ☐ Other | | | |
|
||||
|
||||
---
|
||||
|
||||
## Shift Summary
|
||||
|
||||
| Field | Count |
|
||||
|-------|-------|
|
||||
| Total Specimens Received | |
|
||||
| Surgical Pathology | |
|
||||
| Cytology | |
|
||||
| Frozen Sections | |
|
||||
| STAT/Rush Cases | |
|
||||
| Specimens with Discrepancies | |
|
||||
| Specimens Held/Not Accessioned | |
|
||||
|
||||
---
|
||||
|
||||
## Quality Notes
|
||||
|
||||
*Document any quality issues, equipment problems, or unusual occurrences:*
|
||||
|
||||
---
|
||||
|
||||
## Shift Handoff
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Pending Issues for Next Shift | |
|
||||
| Outstanding Discrepancies | |
|
||||
| Equipment Issues | |
|
||||
| Shift Sign-Off | |
|
||||
| Date/Time | |
|
||||
|
||||
---
|
||||
|
||||
## Supervisor Review
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Reviewed By | |
|
||||
| Date | |
|
||||
| Comments | |
|
||||
| Signature | |
|
||||
|
||||
---
|
||||
|
||||
*Form FRM-PATH-001 Rev 1.0 - Specimen Receipt Log*
|
||||
Reference in New Lab Ticket
Block a user