# Specimen Receipt Log

| Form ID | FRM-PATH-001 | Revision | 1.0 |
|---------|-------------|----------|-----|

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## Log Information

| Field | Entry |
|-------|-------|
| Date | |
| Shift | ☐ Day ☐ Evening ☐ Night |
| Accessioning Technician | |
| Technician ID | |

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## 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) | |

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## 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 |

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## Discrepancy Log

| Time | Accession # | Discrepancy Type | Description | Resolution | Resolved By |
|------|-------------|------------------|-------------|------------|-------------|
| | | ☐ Labeling ☐ Requisition ☐ Condition ☐ Other | | | |
| | | ☐ Labeling ☐ Requisition ☐ Condition ☐ Other | | | |

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## Shift Summary

| Field | Count |
|-------|-------|
| Total Specimens Received | |
| Surgical Pathology | |
| Cytology | |
| Frozen Sections | |
| STAT/Rush Cases | |
| Specimens with Discrepancies | |
| Specimens Held/Not Accessioned | |

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## Quality Notes

*Document any quality issues, equipment problems, or unusual occurrences:*

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## Shift Handoff

| Field | Entry |
|-------|-------|
| Pending Issues for Next Shift | |
| Outstanding Discrepancies | |
| Equipment Issues | |
| Shift Sign-Off | |
| Date/Time | |

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## Supervisor Review

| Field | Entry |
|-------|-------|
| Reviewed By | |
| Date | |
| Comments | |
| Signature | |

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*Form FRM-PATH-001 Rev 1.0 - Specimen Receipt Log*