Collection Materials for Type

12345678|123

Test may not be processed without this information:Test Requisition Form All Tubes

Please Provide:q Patient’s First/last Nameq Date of Birthq Genderq Date of Collection

Please Label:q Patient’s First and Last Nameq Patient’s Date of Birth

46-50 Coombe RoadNew Malden • Surrey KT3 4QF

Call 020.8336.7750 or visit our website at www.gdx.net/uk

SHIP THE SPECIMEN(S) TO THE LABSpecimen(s) must be returned in the Genova Diagnostics provided packaging.Please refer to the shipping instruction insert provided within the test kit.Plan to return your samples by overnight delivery to arrive next day between Monday and Thursday.

Urine container

CHECKLIST (PRIOR TO SHIPPING)

1. All Tubes q Patient's First and Last Name, Gender, and Date of Birth written on container label q Container is tightly closed

2. Tubes - Refrigerated q Urine container 3. Test Requisition Form with Payment q Test Requisition Form is complete Test is marked, Patient’s first and last name, date of

birth, gender, and date of collection are recorded q Payment is included

©2017 Genova Diagnostics Europe IS-MM-42820-UK-0717

SpecimenFirst Morning Urine, 12 ml, refrigerated

Additional Materials• Disposable gloves (2)• Absorbent pad• Ice pack• Test Requisition Form• Biohazard bag with side pocket• Label

ENVIRONMENTALBisphenol A

The following test(s) can be collected using these instructions:

Bisphenol A (BPA) #6007

BISPHENOL A (BPA) SPECIMEN COLLECTION INSTRUCTIONSPATIENT URINE DRAW INSTRUCTIONS

1

7

2

8

9

3

4

5

6

IMPORTANT PREP PRIOR TO TESTING:

For full details refer to: www.gdx.net/tests/prep

24 HOURS BEFORE THE TEST: NIGHT BEFORE THE TESTq Decrease fluid intake to avoid excessive

dilution of the urine. For adults, restrict

intake to one liter or less for 24 hours.

Make sure that no more than ¼ of this

is consumed after 8:00 PM the evening

prior to urine collection.

q Freeze the ice pack.

IMPORTANT:

q It is best to ship your specimen within 24 hours of collection. Please refer to the enclosed shipping instructions before you collect to determine what days you can ship your specimen.

q It is not necessary to discontinue nutritional supplements prior to this specimen collection.

q Do not collect urine during menstruation. q The chemicals being tested are in many

products we use each day such as lotions, soaps, and detergents. Therefore, you MUST collect the urine specimen directly into the provided glass container and follow the instructions below to avoid specimen contamination.

IMPORTANT: To ensure accurate test results you MUST provide the requested information. Write patient’s first and last name, date of birth, gender, and date of collection on the urine container, using a permanent marker.

Write patient’s first and last name, date of birth, gender, and date of collection on the Test Requisition Form

Collect first morning urine directly into the glass container provided in the collection kit. Fill the container at least ¾ full, and void any excess urine into the toilet.

Screw the cap on tightly.

Remove and dispose of gloves appropriately.

Refrigerate the urine container.

Make sure the urine container is tightly closed and identified with a completed label. Place the specimen container, frozen ice pack, and absorbent pad into the Biohazard bag, and seal it securely.

Place samples in the specimen collection box and, close the box.

Seal box with with security seal.

!

COLLEC TION