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Naturopathic Laboratory Manual

Developed and Supplied by: DynaLIFEDx

Suite 200, 10150 –102 Street Edmonton AB T5J 5E2

Revised 2015

Operations Manual Naturopathic Laboratory Testing

Page i

Table of Contents

1.0 Introduction

1.1 Services ............................................................................................................1-1

1.2 Consultation and Support ..................................................................................1-1

2.0 Lab Supplies

2.1 Specimen Containers .......................................................................................2-1

2.2 Ordering Supplies .............................................................................................2-2

• Example Order Form ......................................................................................2-3

3.0 Specimen Identification

3.1 Completing the Requisition ...............................................................................3-1

3.2 Labelling of Specimens .....................................................................................3-1

• Example Requisition ......................................................................................3-2

4.0 Specimen Collection and Preparation

4.1 Order of Tube Draw ..........................................................................................4-1

4.2 Biochemistry – Gold Top (SST) .........................................................................4-1

4.3 Hematology – Light Blue Top ............................................................................4-2

4.4 Hematology Panel – Lavender Top ...................................................................4-2 4.5 Blood Smear Preparation ..................................................................................4-3

4.6 Urinalysis ..........................................................................................................4-4

•••• How to collect urine specimen (female) ............................................................4-5 •••• How to collect urine specimen (male) ...............................................................4-5

4.7 Special Instructions for Trace Element Testing .................................................4-6

4.8 Specimen Requirements Chart .........................................................................4-7

5.0 Clinical Centrifuge Operation

5.1 Specimen and Balance Preparation ..................................................................5-1

5.2 Operation ..........................................................................................................5-1 5.3 Conversion of G-Force to RPM’s ......................................................................5-1 5.4 New and Used Centrifuge Contact ....................................................................5-1

6.0 Packaging

6.1 Materials Required - April 1st to October 31st ...................................................6-1

• Packaging Diagram 6-2

6.2 Materials Required - November 1st to March 31st ............................................6-3


6.3 Frozen Specimen Packaging Using Dry Ice ......................................................6-6


6.4 Transport of Infectious Specimens ....................................................................6-7


Page ii

Table of Contents (Cont’d)

7.0 Courier

7.1 Purolator ...........................................................................................................7-1 •••• Purolator Air Sticker .................................................................................................. 7-2

•••• Infectious Specimens - UN3373 Label ..................................................................... 7-2

•••• Dry Ice Label ............................................................................................................ 7-3

7.2 FedEx ...............................................................................................................7-4

8.0 Specimen Analysis

8.1 Specimen Entry ................................................................................................8-1

8.2 Turn Around Time .............................................................................................8-1

8.3 Test Cancellations ............................................................................................8-1

8.4 Weekends and Holidays ...................................................................................8-1 9.0 Lab Report

9.1 Report Format ...................................................................................................9-1 •••• Example Report .............................................................................................9-2

9.2 Critical Laboratory Values .................................................................................9-3 9.3 Blood Smear Morphology ..................................................................................9-3

10.0 Finance

10.1 Accounts Payable ........................................................................................... 10-1

10.2 Naturopathic Doctor Invoicing ......................................................................... 10-2

10.3 Additional Test Access .................................................................................... 10-2 10.4 Updating Account Information ......................................................................... 10-2

10.5 Account Inactivity ............................................................................................ 10.2

• Example Invoice ..................................................................................................... 10-3

• Example Credit Card Payment Program Authorization Form ................................ 10-4

• Change to Account Form ........................................................................................ 10-5

Section 1.0

Introduction

� Services

� Consultation and Support

Naturopathic Laboratory Testing Operations Manual

Introduction Page 1-1

DynaLIFEDx Rev.3 – June 2015 Proprietary / Confidential

Section 1.0 Introduction

1.1 Services

DynaLIFEDx in association with Medical Consultant Dr. Tris Trethart is pleased to provide laboratory testing to Naturopathic doctors in Western Canada who hold current membership in their national or provincial Naturopathic Association. DynaLIFEDx is a full service, multi-disciplinary medical laboratory, based in Edmonton, Alberta. In this manual you will find instruction regarding:

• specimen collection, preparation, packaging and transport • invoicing and payment of services • fee schedule for available tests

If you have any questions regarding information provided in this manual, please contact DynaLIFEDx. See below Section 1.2 – Consultation and Support, for contact names and extensions.

1.2 Consultation and Support

*Identify yourself as a Naturopathic doctor*

1. Medical Consultant for Naturopathic Laboratory Testing

Dr. Tris Trethart - Contact Karen Fech at 780-757-9133 (direct line) or 780-433-7401 to arrange consultation.

2. DynaLIFEDx

Toll-free ............................................ 1-800-661-9876

Phone ................................................ (780) 451-3702

Specimen Processing ........................................................... Extension

Inquiries (Results, specimen collection or transport) ................... 7100

Shipment Notification ................................................................... 8120

Supply Order Status .................................................................... 8363

Account Updates, New Accounts, Supplies or Service Issues

Faye Chambers, Client Support Specialist .................................. 8189

Email ................................................................. [email protected]

Fax Supply Order Forms .................................................... (780) 454-2950 Billing Inquires – Invoicing and Payments

Accounts Receivable ................................................................... 3554

Section 2.0

Lab Supplies

� Specimen Containers

� Ordering Supplies

� Example Order Form


Lab Supplies

Page 2-1


Section 2.0 Lab Supplies

2.1 Specimen Containers

Gold Top

Vacutainer Tube (SST, 5.0 mL)

Stock# 0580

Pour Off Tubes and Lids

(10.0 mL)

Stock# 1487

Lavender Top

Vacutainer Tube

(EDTA, 4.0 mL)

Stock# 0587

Blue Top

Vacutainer Tube

(Citrate, 2.7 mL)

Stock# 0492

Royal Blue VacutainerTube

(No Preservative, 7 mL)

& Screw Top Transport Vial

Stock# 0510

Royal Blue Vacutainer Tube

(EDTA, 7 mL)

Stock# 0508

Urine Container 60 mL

Stock# 0361

Urine Tube with preservative

and cap

Stock# 1503


Lab Supplies

Page 2-2


2.2 Ordering Supplies

1. Specimen containers and shipping material required for Naturopathic laboratory tests are listed on the “Naturopathic Laboratory Supplies Order Form”, and are provided at no additional charge, for testing being performed at DynaLIFEDx.

2. Upon account set-up, a minimum order of supplies will be shipped to your office.

A personalized order form will also be provided which is to be retained for duplication, as required.

3. To order additional supplies, for testing being performed at DynaLIFEDx, complete your Naturopathic Laboratory Supplies Order Form and fax to (780) 454-2950. Specify the quantity required for each item.

Please Note:

� Please consolidate requests for supplies as much as possible, such as once per month, to assist in controlling shipping costs and thus controlling your testing costs.

� Items are provided individually. Order the exact number that you require.

� The Vacutainer brand tubes supplied usually have an expiry date of three to six months from the date of order. Order quantities accordingly.

� Maximum order guidelines are in place to avoid “expired” products and to control the costs of over-sized shipments.

SUPPLIES ARE SENT BY GROUND TRANSPORT.

ALLOW 5 - 8 DAYS FOR DELIVERY.


Lab Supplies

Page 2-3


Section 3.0

Specimen Identification

� Completing the Requisition

� Labelling of Specimens

� Example Requisition


Lab Supplies

Page 3-1


Section 3.0 Specimen Identification

3.1 Completing the Requisition

Refer to your personalized Requisition for each item listed below.

1. Healthcare Number (PHN) - This number will be used for identification purposes only.

2. Patient’s Name - Patient`s legal name (last name, full first name).

3. Date of Birth - It is imperative that the order day, month, year (DD/MON/YYYY) be followed.

4. Patient Sex - Indicate M (male) or F (female).

5. Phone Patient’s phone number including area code.

6. Postal Code Patient’s postal code.

7. *Collection Date & Time - Day, month, year (DD/MON/YYYY). Time in 24 hour format (i.e., 16:00).

8. *Fasting Status - Indicate number of hours patient was fasting. This is a required field for the laboratory.

*Required fields for sites performing their own collection.

Take care to ensure that the specimen(s) are identified properly. If there are not enough IDENTIFIERS provided on the specimen(s) or the information is inconsistent with

what is submitted on the Requisition, the samples may not be acceptable for analysis.

3.2 Labelling of Specimens

All specimens submitted for testing must be labelled with two identifiers. One must be a name identifier, the patient’s full first and last name, which matches the requisition and provides positive identification of the patient. A second identifier is the date of birth (day/month/year). Due to space limitations, slides submitted for testing, will be accepted with only a name identifier (last name plus full first name or first initial). Label the frosted end of the slide using lead pencil. The following are examples of unacceptable specimens that may NOT be processed:

•••• Specimen is not labelled with the full first and last name and a second identifier like the date of birth (day/month/year)

•••• Specimen is unlabelled •••• Specimen label does not correspond to the information on the requisition •••• Specimen label is on the slide container, transport container or biohazard bag,

and not on the specimen itself


Lab Supplies

Page 3-2


Section 4.0

Specimen Collection and Preparation

� Order of Tube Draw

� Biochemistry – Gold Top (SST)

� Hematology – Light Blue Top

� Hematology Panel – Lavender Top

� Blood Smear Preparation

� Urinalysis

� How to collect urine specimen (female)

� How to collect urine specimen (male)

� Special Instructions for Trace Element Testing

� Specimen Requirements Chart


Specimen Collection and Preparation Page 4-1

DynaLIFEDx Rev. 3: June 2015 Proprietary / Confidential

Section 4.0 Specimen Collection and Preparation

This section describes proper specimen preparation procedures. Care in preparing specimens can be the most critical step in assuring accurate test results.

� Blood should always be drawn prior to exercise to avoid enzyme elevations related to muscle exertion.

� Specimens should only be collected and shipped Monday through Thursday. Avoid shipments on the day prior to a statutory holiday and weekends. Specimens will be delayed and results may be affected.

� Prior to collecting specimens, familiarize yourself with your local courier service schedules to ensure specimens may be picked up in time to provide overnight delivery. Refer to Section 7.0 – Courier, for details.

4.1 Order of Tube Draw

It is very important that the tubes be collected in this order.

1. *First (Trace Metal – no additive) .......................................................... ROYAL BLUE TOP RED LABEL

2. Second .................................................................................................. LIGHT BLUE TOP

3. Third ...................................................................................................... GOLD TOP

4. Fourth .................................................................................................... LAVENDER TOP

5. *Fifth (Trace Metal – additive) ............................................................... ROYAL BLUE TOP MAUVE LABEL

*Trace Metals: Refer to Section 4.7 – Special Instructions for Trace Element Testing, for instructions.

4.2 Biochemistry – Gold Top (SST)

� Label the 5 mL gold top SST tube and transport vials as described in Section 3.2 – Labelling of Specimens.

� Draw blood using routine venipuncture procedures. Use the tourniquet and vacutainer holder.

� Allow the SST tube to fill with blood completely to ensure that enough serum is attained for analysis.

� Remove the tube from the holder and gently invert the gold top tube 8-10 times. This tube contains a clot activator, which must be mixed with the blood sample.

� Allow the blood in the SST tube to clot at room temperature for at least 30 minutes but no longer than one hour.

� Centrifuge the tube (at room temperature) until the cells and serum are separated by a well-formed polymer barrier.

� Using a plastic disposable pipette transfer the serum from the SST tube into the labelled screw top plastic transport vial.

� Refer to Section 4.8 - Specimen Requirements Chart, for minimum volumes and sample requirements for each test. Please submit all of the serum available for all specimens.

� The plastic transport vials containing serum should be refrigerated prior to shipping, unless otherwise indicated.

� Discard the clot tubes as per biosafety requirements.




4.3 Hematology – Light Blue Top

� Label the 2.7 mL blue (Citrate) tube as described in Section 3.2 – Labelling of Specimens.


� Remove the tube from the holder and gently invert the blue top tube 3-4 times. This tube contains an anticoagulant (Citrate), which must be mixed with the blood sample.

� Refer to Section 4.8 - Specimen Requirements Chart, for proper handling.

4.4 Hematology Panel – Lavender Top

� Label the 4 mL lavender (EDTA) tube as described in Section 3.2 – Labelling of Specimens.


�� After removing the needle from the patient’s arm, leave lavender tube on vacutainer needle in holder, and push gently on the end of the tube to express a drop of blood onto each of the two slides, close to the frosted end. Proceed quickly to prepare smears before drops of blood begin to dry. For detailed instructions, read the next section – 4.5 Blood Smear Preparation.

� Remove the tube from the holder and gently invert the lavender top tube 8-10 times. This tube contains an anticoagulant (EDTA), which must be mixed with the blood sample.

X 8-10 � Store the lavender top tube at room temperature prior to shipping.

NOTE: Temperature extremes should be avoided. Test results are optimal on a

specimen kept at room temperature and less than 24 hours old.

When a CBC specimen is >24 hours old and no smear has been sent, the lab:

�� May NOT be able to accurately result RBC, HCT, and RBC indices; no result will

be provided.

�� Will result WBC, HB, platelet and differential.

�� Will add a comment noting specimen >24 hours old.

If a CBC specimen is frozen or exposed to excess heat during transport:

�� Testing cannot be performed; no result can be provided.

Note: Specimens should not be in direct contact with a hot pack or frozen item.




4.5 Blood Smear Preparation

Use a pencil to label the frosted section of each slide with the patient’s name and a second identifier. Do not apply a label to the outside of the slide mailer.

A Hold the lower slide firmly on the counter with the thumb and index finger. Holding the upper “spreader” slide with your thumb and index finger of your other hand, place the edge of the slide in front of the drop of blood at an angle of 30 - 45 degrees.

B Slowly draw the upper slide back into the drop of blood, which will spread it along the edge of the top slide. Do not allow the blood to spread off the edges of the lower slide.

C Keeping the same angle, push the upper slide rapidly along the length of the lower slide. The thickness of the smear can be varied by the rapidity with which the upper slide is pushed; the slower the motion, the thinner the smear. A thin smear is preferred for Hematology evaluation.

D Allow the first slide to air-dry. Proceed the same way for the second slide, using the first slide as the “spreader”.

DynaLIFEDx TIPS:

1. The thickness of the smear can be varied by the rapidity with which the upper slide is pushed; the

slower the motion, the thinner the smear. A thin smear is preferred for hematology evaluation.

2. Good smears result from numerous slide preparations. For each patient, make several smears and submit the 2 best smears.

3. When blood smears are too thick, they tend to “wash off” the slide during the staining process.

4. When blood smears are not made immediately following venipuncture, ensure tube of blood is thoroughly mixed prior to making blood smears.




4.6 Urinalysis

Instruct the patient to collect approximately 40 mL of midstream urine in a 60 mL urine container (refer to the following page for collection instructions).

Label a 10 mL urine transport tube as described in Section 3.2 – Labelling of Specimens.

Do not remove the preservative tablet.

Fill to the top of the label, if possible (less than 3 mL will not be processed).

Ensure the cap on the urine transport tube is secured tightly to prevent leakage.

Seal urine transport tube in a clear ziplock bag.

Refrigerate the specimen prior to shipping.




4.7 Special Instructions For Trace Elements Testing – Zinc, Copper, Lead, Mercury

Serum (for Zinc and Copper testing):

1. Perform venipuncture, wearing non-powdered gloves using stainless steel phlebotomy

needle with plastic hub. Collect trace metal specimens first if multiple specimens are required.

2. Draw blood into 7 mL Monoject tube, Royal Blue stopper, no additive, silicone coated tube (Stock# 0510 – includes Sarstedt transport vial).

3. Allow 30-60 minutes (maximum) for clotting, centrifuge, and pour serum (or transfer with a plastic pipette) into the provided metal free polypropylene plastic screw top transport vial (Sarstedt vial).

4. Store and send sample refrigerated.

Whole Blood (for Lead testing):

1. Perform venipuncture, wearing non-powdered gloves using stainless steel phlebotomy needle with plastic hub. Collect trace metal specimens first if multiple specimens are required.

2. Draw blood into 7 mL Monoject tube, Royal Blue stopper, powdered additive (Na2EDTA), non-silicone coated tube (Stock# 0508).

3. Thoroughly mix the blood. Do no transfer to another container; whole blood sample required.

4. Store and send sample refrigerated.




4.8 Specimen Requirements Chart

This chart provides specimen container and processing information. This information is based on shipping samples via overnight courier with receipt by lab within 24 hours of collection.

TEST NAME TEST CODE

TEST INFORMATION SAMPLE REQUIREMENTS SUBMIT

Panel 1 – Fasting Panel 1 – Non-Fasting Individual Test Included in the Panels

DK23F DK23

A/G Ratio, Albumin, Alkaline Phosphatase, Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Bilirubin (Total & Conjugated), Calcium, Chloride, Cholesterol, Total CO2, Creatinine, Gamma Glutamyl Transferase (GGT), Globulin, Glucose, Lactate Dehydrogenase (LD), Phosphorus, Potassium, Sodium, Total Protein, Triglyceride, Urate, Urea

2 SST (GOLD TOP) Tubes for full panel 1 SST (GOLD TOP) for individual tests in panel.

Plastic Transport Vial 3.0 mL of serum for full panel or 1.0 mL serum for individual tests in the panel.

Panel 14 Individual Test Included in the Panel

DK17 Estradiol, Follicle Stimulating Hormone, Luteinizing Hormone, Progesterone, Prolactin, Testosterone

2 SST (GOLD TOP) Tubes for full panel 1 SST (GOLD TOP) for individual tests in panel.

Plastic Transport Vial 3.0 mL of serum for full panel or 1.0 mL serum for individual tests in the panel

Panel 20 Individual Test Included in the Panel

DK15 TSH, T3 Free and T4 Free 1 SST (GOLD TOP) Tubes Plastic Transport Vial 1.0 mL of serum

Alanine Aminotransferase ALT Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Albumin ALB Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Albumin: Creatinine, random urine

UALBR UCRER

Run daily 5 - 10 mL of random urine collected in 60 mL urine container (Stock#0361)

Plastic Transport Vial 5.0 mL of serum Indicate specimen type (urine) on transport vial Do NOT use urine tube with preservative tablet Send on cold pack

Alkaline Phosphatase ALP Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Alpha-1 Antitrypsin A1AT Run Monday – Friday 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Alpha Fetoprotein AFP Run Monday – Friday For males and non-pregnant females

1 SST (GOLD TOP) Tube

Plastic Transport Vial 1.0 mL of serum

Anti-DNA DNAA Run Twice weekly 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum Send on cold pack

Anti- Nuclear Antibody ANA Run Monday – Friday

1 SST (GOLD TOP) Tube Plastic Transport Vial

1.0 mL of serum Anti-Smooth Muscle ACTA Run biweekly 1 SST (GOLD TOP) Tube Plastic Transport Vial

1.0 mL of serum FREEZE IMMEDIATELY

Ship on dry ice

Anti-Streptolysis O ASOT Run Monday – Friday 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Anti-Transglutaminase IgA ATTG Run Monday – Friday

1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum FREEZE IMMEDIATELY Ship on dry ice

Aspartate Aminotransferase

AST Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Bioavailable Testosterone DBTST Collect specimen between 7 am and 10 am TAT: 14 days

1 SST (GOLD TOP) Tube Plastic Transport Vial 2.0 mL of serum FREEZE IMMEDIATELY Ship on dry ice




TEST NAME TEST CODE


CA 125 CA125 Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum Send on cold pack

C-Reactive Protein CRP Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Calcium, serum CA Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Calcium : Creatinine, random urine

UCRCA Run daily 10 mL of random urine collected in 60 mL urine container

Plastic Transport Vial 10 mL of serum Indicate specimen type (urine) on transport vial Do NOT use urine tube with preservative tablet Send on cold pack

Carbamazepine CARB Run daily 1 SST (GOLD TOP) Tube Collect < 60 minutes pre-dose, or > 12 hours post dose


Carbon Dioxide CO2 Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Carcinoembryonic Antigen CEA Run Monday – Friday 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum Send on frozen ice pack

Chloride CL Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Cholesterol CHOL Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Complement 3 C3 Run Monday – Friday 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Complement 4 C4 Run Monday – Friday 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Complete Blood Count + Differential

CBCD Run daily CBC (HCT, Hgb, RBC Indices, Platelets, & WBC) & Differential

1 Lavender Top Tube Test within 24 hours of collection

1 Lavender Top Tube and 2 blood smears in slide container (Stock# 0462) DO NOT REFRIGERATE See Section 4.4, 4.5

Conjugated Bilirubin CBIL Run daily 1 SST (GOLD TOP) Tube PROTECT TUBE FROM LIGHT (wrap tube in tin foil)

Plastic Transport Vial 1.0 mL of serum PROTECT TUBE FROM LIGHT (wrap tube in tin foil)

Copper, serum SCU Run weekly See special instructions for Trace Element Testing prior to this section, for collection procedure.

1 Royal Blue Top Tube (no preservative) and 8 mL screw top aliquot vial (Stock# 0510)

Spin sample. Aliquot serum using plastic pipette into 8 mL screw top vial provided. DO NOT USE GLASS Send on cold pack

Cortisol, serum, random CORS Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Creatine Kinase CK Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Creatinine, serum CREA Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Creatinine, random urine UCRER Run daily 10-15 mL of random urine collected in 60 mL urine container

Plastic Transport Vial 10 mL of serum Indicate specimen type (urine) on transport vial Do NOT use urine tube with preservative tablet Send on cold pack

D-Dimer

QDDIM Run daily 1 Light Blue Top Tube (Citrate) (Completely filled) Centrifuge tube and transfer a minimum of 2.0 mL of plasma into plastic transport vial (Stock#1487), use a pipette.

Plastic Transport Vial 2.0 mL of plasma FREEZE IMMEDIATELY Ship on dry ice

DHEAS Dehydroepiandrosterone Sulfate

DHEAS Run Monday, Wednesday, Friday

1 SST (GOLD TOP) Tube Centrifuge tube and transfer a minimum of 2.0 mL of serum into plastic transport vial (Stock#1487), use a pipette.

Plastic Transport Vial 2.0 mL of plasma Ship on dry ice




TEST NAME TEST CODE


Digoxin DIG Run daily 1 SST (GOLD TOP) Tube Collect < 60 minutes pre-dose or 6 - 8 hours post-dose


ENA ENAS Run 2x / week Includes anti-SSA, anti-SSB, anti-SM and anti-RNP

1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum Send on cold pack

Epstein Barr IgM Antibody (Viral Capsid Antibody)

EBM Run Biweekly For diagnosis of acute EBV infection (mononucleosis)

1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Estradiol E2 Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Ferritin FER Run daily Preferred test for determining Iron status.


Fibrinogen FIB Run daily 1 Light Blue Top Tube (Citrate) (Completely filled)

Light Blue Top Tube

Folate FOL Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Follicle Stimulating Hormone

FSH Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

G6PD Screen G6PDS Run Monday – Friday

Collect Monday thru Thursday only

Quantitative assay will be performed if screen is deficient or equivocal.

1 Lavender Top Tube - Order CBCD OR send CBC result if available

REFRIGERATE IMMEDIATELY Send on cold pack

Gamma Glutamyl Transferase

GGT Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Glucose, fasting GLUCF Run daily – FASTING 8 hrs. 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Glucose, random GLUCR Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Glycated Hemoglobin HBA1C Run Monday – Friday 1 Lavender Top Tube

1 Lavender Top Tube

Haptoglobin DHAPT Run weekly 1 SST (GOLD TOP) Tube Centrifuge tube and transfer a minimum of 2.0 mL of serum into plastic transport vial (Stock#1487), use a pipette.

Plastic Transport Vial 2.0 mL of serum Ship on dry ice

HDL HDL Run daily - If patient is fasting, record # of hours on requisition



Hemoglobinopathy Investigation

THAL Run biweekly Includes HbA2, HbF, and HbH

1 Lavender Top Tube – Order CBC and Ferritin OR send Ferritin result if available.

1 Lavender Top Tube

Hemoglobin S Screen SHBS Run daily 1 Lavender Top Tube (Completely filled)

1 Lavender Top Tube

Hepatitis A IgG Antibody HAVG Run Monday – Friday For assessment of immunity


Hepatitis B Surface Ab HSAB Run daily For assessment of immunity


Homocysteine DHCYS Run twice weekly 12 hrs. FASTING (9hrs for diabetics)

1 Lavender Top Tube Within one hour of collection: centrifuge tube and transfer a minimum of 2.0 mL of plasma into plastic transport vial (Stock#1487), use a pipette.

Plastic Transport Vial 2.0 mL of plasma Indicate specimen type (plasma) on transport vial FREEZE IMMEDIATELY Ship on dry ice

Human Chorionic Gonadotropin

HCG Run Monday - Friday 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

IGE IGE Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Immunoglobulin Quantitation IgA, IgG, IgM,

IGQ Run Monday – Friday 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Insulin DINS Run twice weekly – FASTING 8 hrs.

1 SST (GOLD TOP) Tube Plastic Transport Vial 2.0 mL of serum Ship on dry ice




TEST NAME TEST CODE


Iron, Total Iron Binding Capacity, Saturation Index

FE Run daily Fasting specimen preferred



Lactate Dehydrogenase LD Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Lead, blood WBPB Run weekly See special instructions for Trace Element Testing prior to this section, for collection procedure.

7 mL Royal Blue with EDTA (Stock# 0508) Thoroughly mix blood DO NOT transfer to another container

7 mL Royal Blue with EDTA Send on cold pack

Lipase LPS Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Lipid Panel LDL Run daily Includes Cholesterol, Triglyceride, HDL and LDL Cholesterol (calculated) If patient is fasting, record # of hours on requisition



Luteinizing Hormone LH Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Magnesium, serum MG Run daily


Mononucleosis Screen MONOS Run daily


Osmolality, serum OSM Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 2.0 mL of serum

Parathyroid Hormone PTH Run daily

1 SST (GOLD TOP) Tube - Order Calcium OR send Calcium result if available. Centrifuge tube and transfer a minimum of 2.0 mL of plasma into plastic transport vial (Stock#1487), use a pipette.

Plastic Transport Vial 2.0 mL of serum FREEZE IMMEDIATELY Ship on dry ice

Phenobarbital PHB Run daily 1 SST (GOLD TOP) Tube Collect < 60 minutes pre-dose or > 2 h post dose


Phenytoin PTN Run daily 1 SST (GOLD TOP) Tube Collect < 60 minutes pre-dose or > 2 h post dose.


Phosphorous PO4 Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Potassium K Run daily Avoid hemolysis

1 SST (GOLD TOP) Tube Centrifuge tube within 30 min of collection.


Progesterone PROG Run daily When used as a test for ovulation, sampling should be done in mid-luteal phase


Prolactin PRL Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Prostate Specific Antigen PSA Run daily 1 SST (GOLD TOP) Tube


Free PSA Free Prostate Specific Antigen

FPSA Run weekly Total PSA, Free PSA, Free/Total PSA Ratio



Protein Electrophoresis SPE Run Monday – Friday Includes Total Protein & Albumin. Immunofixation will be performed if indicated.


Reticulocyte RETIC Run daily 1 Lavender Top Tube 1 Lavender Top Tube (Completely filled)

Rheumatoid Factor RA Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Rubella IgG RUBG Run twice weekly For assessment of immunity


Sodium NA Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum




TEST NAME TEST CODE


T3, Free FT3 Run daily 1 SST (GOLD TOP) Tubes Plastic Transport Vial 1.0 mL of serum

T4, Free FT4 Run daily

1 SST (GOLD TOP) Tubes Plastic Transport Vial 1.0 mL of serum

Testosterone TEST Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Theophylline THEO Run daily 1 SST (GOLD TOP) Tube Collect < 60 minutes pre-dose or > 2 h post dose


Thyroid Antibody (Microsomal Antibody)

TPO Run Monday – Friday Preferred test for thyroid autoimmune disease


Thyroid Stimulating Hormone

TSHBO Run daily 1 SST (GOLD TOP) Tube


Total Bilirubin TBIL Run daily 1 SST (GOLD TOP) Tube PROTECT TUBE FROM LIGHT (wrap tube in tin foil)

Plastic Transport Vial 1.0 mL of serum PROTECT TUBE FROM LIGHT (wrap tube in tin foil)

Total Protein TP Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Triglyceride TRIG Run daily If patient is fasting, record # of hours on requisition



Urea (BUN) URE Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Urea Breath Test (H. Pylori)

DUB Run Monday – Friday ND will be invoiced immediately upon shipment of kit. Check expiry date on kit prior to collection.

H. Pylori collection kits (Stock#1780) Samples are stable by temperature variation.

Complete Breath Test Kit as per instructions provided. Sample may be batched and shipped along with your other samples

Uric Acid (Urate) UA Run daily 1 SST (GOLD TOP) Tube Plastic Transport Vial 1.0 mL of serum

Urinalysis UMA UMIC

Run daily Collect a fresh midstream urine in 60 mL urine container (Stock#0361)

10 mL urine in Tube with preservative (Stock# 1503)

Valproate VA Run daily 1 SST (GOLD TOP) Tube Collect < 60 minutes pre-dose or > 12 h post dose


Vitamin A VITA TAT 3 weeks 1 SST (GOLD TOP) Tube PROTECT TUBE FROM LIGHT (wrap tube in tin foil)


Vitamin B12 B12 Run daily Order only if B12 deficiency is suspected Do NOT use as a screen for B12 deficiency



Vitamin E VITE TAT 3 weeks 1 SST (GOLD TOP) Tube PROTECT TUBE FROM LIGHT (wrap tube in tin foil)


Zinc, serum SZN Run twice per week See special instructions for Trace Element Testing prior to this section, for collection procedure.

1 Royal Blue Top Tube (no preservative) and 8.0 mL screw top aliquot vial (Stock#0510)

Spin sample Pipette serum into 8.0 mL screw top vial provided DO NOT USE GLASS Send on cold pack

Refrigerate Plastic Transport Vials containing serum/plasma/urine until shipment unless otherwise indicated.

Blue font indicates which samples should be sent frozen.

If the symbol appears, then that particular test must be shipped on dry ice, otherwise it can be

shipped on a frozen ice pack for ease.

Refer to the following page for collection and processing tips.




DynaLIFEDx Tips:

1. To assist in determining the # of SST Tubes to draw for multi-test requests:

• A full 5 mL SST (Gold Top) Tube will provide approximately 2.0 mL of serum when spun

• For every individual test requiring serum, submit 1.0 mL of serum (unless indicated otherwise)

2. If multiple specimen types are submitted on the same patient, label container with specimen type. Example: serum (gold top collections), plasma (lavender top tubes), urine.

3. Check expiry date on vacutainer tubes prior to collection.

Section 5.0

Clinical Centrifuge Operation

� Specimen and Balance Preparation

� Operation

� Conversion of G-Force to RPM’s

� New and Used Centrifuge Contact


Clinical Centrifuge Operation Page 5-1

DynaLIFEDx Rev.3– June 2015 Proprietary / Confidential

Section 5.0 Clinical Centrifuge Operation

5.1 Specimen and Balance Preparation

� Let the blood sample clot for 30 minutes before spinning.

� If you have an uneven number of tubes to centrifuge at the same time, fill an empty tube with water to the same height as the tube containing the blood sample and use it as a balance for spinning in the centrifuge.

� Place the balance tube and patient sample into opposite shields of the centrifuge.

Warning: An unbalanced centrifuge will shake violently during operation and may cause tubes to break. Please ensure your samples are balanced and placed directly opposite each other in the centrifuge.

5.2 Operation

� Close the lid and set speed dial to the number of rpm's required for 1300 g (see chart below). Spin blood for 10 minutes.

� Due to variations in centrifuges, it may be necessary to spin the SST tubes longer or faster to achieve the desired ratio of equal volumes of serum above and clot below the separator gel.

� A properly spun serum sample will result in three distinct layers:

1. Serum, clear yellow fluid on top 2. Gel, whitish-yellow in the centre

3. Clot, deep red on the bottom � A hemolyzed serum will appear as a clear pink to red fluid on top. This is not an

acceptable sample and will have to be recollected.

5.3 Conversion of G-Force to RPM’s

The revolutions per minute (rpm’s) have been calculated using a gravity force of 1300 g.

Radius centrifuge (Distance in cm from centre of the tube to axis of

centrifuge)

Revolutions per Minute

5 4 900

6 4 200

7 4 000

8 3 800

9 3 600

10 3 400

11 3 200

12 3 100

13 3 000

14 2 850

5.4 New and Used Centrifuge Contact

Contact for new and used centrifuges is Intiquip located in Regina, SK @: 306-584-3993.

Section 6.0

Packaging

� Materials Required, April 1st to October 31st

� Packaging Diagram

� Materials Required, November 1st to March 31st


� Frozen Specimen Packaging Using Dry Ice


� Transport of Infectious Specimens


Packaging Page 6-1


Section 6.0 Packaging

Depending on the time of year there are different packaging procedures for the ambient lab samples. Refer to the appropriate seasonal time frame and follow the instructions carefully. It is the responsibility of the shipper to ensure the specimens are prepared in accordance with IATA Packing Instruction 650. IATA shipper training requirements can be found in the IATA Dangerous Goods Regulations that can be ordered on-line at https://www.iataonline.com/.

As a shipper you are responsible for:

• using the correct supplies to package specimens

• following the packaging instructions provided by DynaLIFEDx

• labeling the packages and over package (courier envelope) according to the IATA Guidelines

Store specimen(s) at temperature indicated in Section 4.0 - Specimen Collection and Preparation and package one hour before courier pickup.

6.1 Materials Required - April 1st to October 31st

It is the responsibility of the shipper to ensure packaging instructions are followed carefully in complying with requirements for Transportation of Diagnostic Specimens, and maintaining optimum specimen integrity. Transport couriers will reject boxes improperly packaged and the shipper may be subject to large fines if packages are found to be leaking. The materials below will be required for shipping during April 1st to October 31st. Please refer to the diagram on the following page for instruction.

Specimen Biohazard Bag (Stock# 1490)

with absorbent (Stock# 1396) Bubble Pack (5 pocket)

(Stock# 1660) Shipping Box (Stock# 1517)

(approx 9” x 4” x 4”)


Packaging Page 6-2


Packaging Diagram – April 1st to October 31st

Blood Samples

� Tighten transport vial lids to prevent leakage. Insert the tubes into the bubble pack. (One vial per sleeve of the bubble pack).

� Do not include frozen specimens in the same bubble pack with the lavender top tubes. � Roll up the bubble pack and place it inside the zippered compartment of the specimen

biohazard bag, containing the absorbent. Each biohazard bag should only contain the specimens of a single patient.

Requisition

� Complete the requisition ordering only the ambient (room temperature and refrigerated) tests required for the patient.

� Fold the top copy of the Requisition and slip it into the sleeve compartment of the specimen biohazard bag; one requisition per patient.


Packaging Page 6-3


Urine Samples

� Place urine specimen tube (as per test requirements) into a separate ziplock bag (seal the ziplock bag securely) and then into the ziplock compartment of the biohazard bag with other specimens.

Shipping Box

� Enclose all biohazard bags inside the shipping box by replacing the lid and securing the box with tape. Use one shipping box for transporting all specimens from several patients shipped on the same day.

� Call Specimen Receiving at 1-800-661-9876, extension 8120, with the waybill number(s), each time that you ship. This assists in initiating the tracking of specimens that are not received. Note: You may be asked for other information regarding shipment.

� Ensure that one copy of each waybill is retained at your site for tracking purposes.

6.2 Materials Required - November 1st to March 31st

It is the responsibility of the shipper to ensure these packaging instructions are followed carefully. Transport couriers will reject boxes improperly packaged and the shipper may be subject to large fines if packages are found to be leaking.

The materials below will be required for shipping during November 1st to March 31st. Please refer to the diagram on the following page for instruction.

Specimen Biohazard Bag (Stock# 1490)

with absorbent (Stock# 1396) Bubble Pack (5 pocket)

(Stock# 1660)

Hand-warmer

(Stock# 2052) Outer Shipping Box (Stock# 1504)

with styrofoam box liner (Stock# 1506)

(approx 8” x 8” x 13”)


Packaging Page 6-4


Packaging Diagram - November 1st to March 31st

The following procedure is to be used when shipping specimens to DynaLIFEDx to prevent temperature sensitive specimens from freezing (CBCD specimens).

Lavender (EDTA) Tubes

+

=

Bubble Pack

Activated Hand-warmer

Plastic Transport Vials

“Packaging Supplies” (1) Styrofoam-lined shipping box (1) Hand-warmer (1) Bubble pack (1) Biohazard bag with absorbent (1) Elastic band


Packaging Page 6-5


Lavender (EDTA) Tubes (+ Hand-warmer)

� Insert the lavender (EDTA) tubes into the bubble pack. Up to three tubes (from several patients) may be packaged together in the same bubble pack.

� Activate the hand-warmer by removing the plastic wrap. Wrap the bubble pack around the activated hand-warmer and secure with the rubber band. Do not allow the specimens to make direct contact with the hand-warmer, as this will destroy the blood.

� Place the secured lavender tubes inside the zippered compartment of the specimen biohazard bag, containing the absorbent. Seal the zippered bag securely.

Plastic Transport Vials / Blue (Citrate) Tubes

� Tighten the lids on the transport vials to prevent leakage and insert the vials into the bubble pack.

� Insert the blue (Citrate) tubes into the bubble pack.

� Roll up the bubble pack and place it inside the zippered compartment of the specimen biohazard bag, containing the absorbent. Each biohazard bag should only contain the specimens of a single patient.

Requisition

� Complete the requisition ordering only the ambient (room temperature and refrigerated) tests required for the patient.

� Fold the top copy of the Requisition and slip it into the sleeve compartment of the biohazard bag containing the plastic transport vials.

Urine Samples

� Place urine specimen tube (as per test requirements) into a separate ziplock bag (seal

the ziplock bag securely) and then into the ziplock compartment of the biohazard bag with other specimens.

Shipping Box

� Enclose all biohazard bags inside the styrofoam-lined shipping box by replacing the lid and securing the box with tape. Use one winter shipping box for transporting all specimens from several patients shipped on the same day.

� Call Specimen Receiving at 1-800-661-9876, extension 8120, with the waybill number(s), each time that you ship. This assists in initiating the tracking of specimens that are not received. Note: You may be asked for other information regarding shipment.

� Ensure that one copy of each waybill is retained at your site for tracking purposes.


Packaging Page 6-6


6.3 Frozen Specimen Packaging Using Dry Ice

The following procedure is to be used when shipping frozen specimens requiring dry ice, to prevent specimens from thawing in transit. (Specimens are unsuitable if received thawed.)

Packaging Diagram – Dry Ice Shipments

Dry Ice

Dry Ice

Bubble Pack

“Frozen Packaging Supplies” (1) Styrofoam-lined shipping box with Dry Ice label (1) Bubble pack (1) Biohazard bag with absorbent


Packaging Page 6-7


Dry Ice

� Partially fill the styrofoam-lined shipping box with dry ice.

Plastic Transport Vial(s)

� Tighten the lids to prevent leakage and insert the vials into the bubble pack.

� Roll up the bubble pack and place it inside the zippered compartment of the specimen biohazard bag, containing the absorbent. Each biohazard bag should only contain the specimens of a single patient. Seal the biohazard bag securely.

Requisition

� Complete the requisition ordering only the frozen tests required for the patient.

� Fold the middle copy of the Requisition and slip it into the sleeve compartment of the specimen biohazard bag.

“Frozen Packaging Supplies” Shipping Box

� Place the biohazard bag(s) directly on the dry ice (inside the shipping box).

� Add dry ice on top of the biohazard bag(s) containing specimens until full.

� Replace the styrofoam lid and tape the flaps of the frozen shipping box securely. Do not use tape to secure the styrofoam lid (as the dry ice evaporates, the gas that is produced must be allowed to escape freely). Use one frozen shipping box for transporting all specimens from several patients shipped on the same day.

� Ensure the box is properly labelled with the net weight of dry ice, marked in kilograms (i.e., 3 Kg), proper shipping name (Dry ice), UN number (UN1845), primary risk label with class (Class 9), your name and address. Our return address is stamped on the label.

Waybill

� Use a waybill that contains a description of the dry ice. See Section 7.0 - Courier.

DynaLIFEDx TIPS:

1. Ship frozen specimens Monday through Wednesday only.

2. Be sure that the waybill you have completed contains a description of the dry ice.

3. DO NOT COVER “Exempt Human Specimen” marking on shipping box.

6.4 Transport of Infectious Specimens

NOTE: When a patient is diagnosed with an infectious disease and the organism could be present in the blood or urine specimen, then the specimen is classified as a Biological Substance, Category B. Examples include diagnosed Hepatitis and HIV. Category B specimens transported by air must be shipped according to the above instruction and assigned to UN3373. Apply the UN3373 label to the outer shipping box of specimens meeting these requirements. Remember to change Section 5 of Purolator waybill to read Biological Substance, Category B, UN3373.

Section 7.0

Courier

� Purolator

� Purolator Air Sticker

� Infectious Specimens - UN3373 Label

� Dry Ice Label

� FedEx

Laboratory Operations Manual

Naturopathic Laboratory Testing Page 7-1


Section 7.0 Courier

Courier fees are not included in the cost of testing specimens at DynaLIFEDx. Naturopaths must have their own courier account, with the overnight courier of their choice. Please avoid shipments prior to a Statutory Holiday, Fridays and weekends, as specimens are more likely to be delayed in transit and your results will be compromised.

7.1 Purolator Courier

Call Purolator at 1-800-387-3027 to discuss service for your site. They will advise you of pick-up times available to you and what time of day you will need to call to arrange the pick-up to ensure overnight delivery.

To ensure prompt delivery and accurate billing follow these directions when completing the waybill.

Use only one waybill for packages sent together (Multiple piece shipment).

Area Complete Reference Description / Instructions

1 Complete Consignee DynaLIFEDx

2 Complete Sender Shipping date

3 Complete Sender Your name and complete address. 4 Complete Receiver DynaLIFEDx #200, 10150-102 Street, Edmonton, AB T5J 5E2.

Attn: Specimen Processing 5 Complete Description Exempt Human Specimen

Dry Ice Waybills: Exempt Human Specimen/ Dry Ice, 9, UN1845, 1x3 Kg, IATA650, III, 904 Dangerous Goods Shipper Declaration Not Required

6 Complete Sender Complete if you require this information.

7 Complete Sender Sender's signature, please sign.

8 Complete Service AIR �� If you are shipping on Friday or any day prior to a Statutory Holiday:

� Mark SATURDAY SERVICE ��

� Ask for Weekender Stickers to be placed on package(s). 9 Complete Charges Sender ��

10 Complete Package � Enter number of pieces.

� Enter approximate weight. 11 Complete Package NCV {No Commercial Value}

Call Specimen Receiving (DynaLIFEDx) at 1-800-661-9876, Ext. 8120, with the following information each time that you ship specimens:

1. Waybill number(s)

2. Location you are calling from

3. Contact name and phone number 4. Indicate if the shipment contains dry ice or is marked for “Saturday Service”

Without telephone notification, Specimen Receiving

will not be responsible for tracking missing packages.




Purolator “AIR Sticker”

This “AIR Sticker” must be placed on every box shipped to DynaLIFEDx. This will help to flag your package so that the shipment will be sent by air; otherwise the shipment will be sent by ground, resulting in delayed receipt of specimens and possible sample compromise. This sticker can be ordered through Purolator.

Infectious Specimens - UN3373 Biological Substance, Category B Label

Used for shipping Category B Infectious Specimens transported by air. Examples include diagnosed infections of Hepatitis and HIV. Apply the UN3373 label to the outer shipping box covering the “Exempt Human Specimen” marking. The sticker can be ordered through DynaLIFEDx and is only required for known Infectious Specimens. Remember to change Section 5 of Purolator waybill to read Biological Substance, Category B, UN3373.




Dry Ice Label

This dry ice sticker must be placed on every dry ice box shipped to DynaLIFEDx. All blank areas must be filled in on the sticker. (* These points must be documented in section 5 on the original Purolator waybill.*)




7.2 FedEx Courier

Call Federal Express at 1-800-GO-FEDEX (1-800-463-3339) to discuss service for your site. They will advise you of pick-up times available to you and what time of day you will need to call to arrange the pick-up to ensure overnight delivery. To ensure prompt delivery and accurate billing follow these directions when completing the waybill.

Use only one waybill for packages sent together (Multiple piece shipment).

Area

Complete

Reference Description / Instructions

1 Complete From Date and your name, complete address, and telephone number.

2 Complete Reference Complete if you require this information.

3 Complete To DynaLIFEDx #200, 10150-102 Street, Edmonton, AB T5J 5E2. Attn: Specimen Processing

4 Complete Shipment Information

Enter number of pieces. Enter approximate weight and check lb or kg Enter approximate dimensions.

� Kit box = 9 x 4 x 4 (in) � Winter Packaging Supplies box = 8 x 8 x 13 (in)

NCV (No Commercial Value)

5 Complete Service �� FEDEX PRIORITY OVERNIGHT 6 Complete Packaging �� Other Pkg

7 Complete for Saturday delivery

Special Handling

�� Exempt Human Specimen. Also, if you are shipping on Friday, mark �� SATURDAY DELIVERY and ask for Saturday delivery stickers to be placed on package(s).

8 Complete Payment �� Sender

9 Leave Blank Release Signature

Do not sign. A signature is required for package delivery.

10 Complete Signature Sender’s signature, please sign and date.

Call Specimen Receiving (DynaLIFEDx) at 1-800-661-9876, Ext. 8120, with the following information each time that you ship specimens:

1. Waybill number(s) 2. Location you are calling from

3. Contact name and phone number

4. Indicate if the shipment contains dry ice or is marked for “Saturday Service”

Without telephone notification, Specimen Receiving

will not be responsible for tracking missing packages.

Section 8.0

Specimen Analysis

� Specimen Entry

� Turn Around Time

� Test Cancellations

� Weekends and Holidays




Section 8.0 Specimen Analysis

8.1 Specimen Entry

On arrival at DynaLIFEDx, the condition of the specimens and completeness and consistency of the information on the requisition will be assessed.

The shipping site will be contacted if the technical condition of the specimen is unacceptable, absence of information, or inconsistencies on the requisition is noted.

8.2 Turn Around Time

Most results are available 24hrs after samples are received at DynaLIFEDx.

Refer to Section 4-8 – Specimen Requirements Chart, for more details.

Overdue Results

If a report appears to have an excessive turn around time, please do not hesitate to call us at 1-800-661-9876 ext. 7100. DynaLIFEDx staff can view the data to ensure each test has been requested. We can immediately produce a report that will contain all of the results available to date for a particular collection. This report can be mailed, as necessary.

8.3 Test Cancellations

The lab reserves the right to cancel testing on unsuitable specimens (clotted, insufficient sample, etc.) or to reject specimens due to insufficient patient identifiers or misidentification. Your office will be informed about unacceptable specimens. The lab will not reimburse cost of courier fees. Both the cancellation and reason are noted on the lab report.

8.4 Weekends and Holidays

DynaLIFEDx operates 24 hours per day, 365 days per year. However, commercial courier delivery is restricted to Monday through Saturday, some holiday restrictions apply. Check with your chosen courier for holiday restrictions.

Section 9.0

Lab Report

� Report Format

� Example Report

� Critical Laboratory Values

� Blood Smear Morphology




Section 9.0 Lab Report

9.1 Report Format

For the following items, please refer to the specimen report form shown on the following page.

1. Patient name, healthcare and/or chart number, birthdate, age and sex are noted under the appropriate headings.

2. The Naturopathic Doctor name and address will appear on the right hand side of the

report. 3. The laboratory accession number (assigned by DynaLIFEDx), to the left of the collection

date.

4. The collection date and time and the received date and time are noted immediately below the header INFO LINE.

5. “cc” provides name of physician receiving a copy of the report and DynaLIFEDx contact

for critical laboratory results. • Additional comments will appear next to the fasting status following the heading

"INFO:" or in the result column next to “IMPORTANT NOTICE”. 6. Specific analytes are listed in the test name column. 7. Out of range results will be flagged as: H (high), L (low) or C (critical). 8. The result will appear in the result column. 9. Reference ranges and units will be printed if appropriate.

10. Reporting units are noted in the right column.

11. Date and time reported are shown on the bottom right of the report page.




1

cc2: Trethart, DR. Tris

�

�

�

� � �

11

CC 1:MCBLUE,DR.B (ND)

HEALTH CLINIC

10150 – 102 Street Suite 200 Edmonton AB Canada T5J 5E2 Phone (780) 451-3702 1-800-661-9876 Fax : (780) 454-2950

�

DynaLIFE DX

Naturopathic Laboratory Testing




9.2 Critical Laboratory Values

A critical laboratory value is a value at such variance with normal as to represent a pathophysiologic state that is life-threatening unless some action is taken in a very short time and for which an appropriate action is possible. Critical Laboratory Values according to DynaLIFEDx laboratory policy must be telephoned to the physician as soon as possible after the result is available. The Medical Consultant for Naturopathic Laboratory Testing (Dr. Tris Trethart) provides review of all Naturopathic Laboratory Testing, and is DynaLIFEDx physician contact for all critical naturopath laboratory values. Dr. Tris Trethart will contact the naturopathic doctor to discuss the patient history and recommend treatment. Reasonable efforts will be made by DynaLIFEDx to reach the Medical Consultant. All actions taken to advise the Medical Consultant of the critical result will be documented.

9.3 Blood Smear Morphology

At DynaLIFEDx, a Blood Smear Morphology (Pathologist Check/PC) is added to a CBCD report at the discretion of the reviewing pathologist, to assist in patient management.

Section 10.0

Finance

� Accounts Payable

� Naturopathic Doctor Invoicing

� Additional Test Access

� Updating Account Information

� Account Inactivity

� Example Invoice

� Example Credit Card Payment Authorization Form

� Change to Account Form




Section 10.0 Finance

10.1 Accounts Payable

DynaLIFEDx Finance Department completes the invoicing and payment process for your account. DynaLIFEDx Finance Department is located in Edmonton and can be contacted during business hours from 8:00 am to 4:00 pm, Monday through Friday at:

DynaLIFEDx ATTENTION: ACCOUNTS RECEIVABLE

Suite 200, 10150 – 102 Street, Edmonton, AB, T5J 5E2 Tel: (780) 451-3702 ext. 8193 Secure Fax: (780) 701-1720

Email: [email protected]

DynaLIFEDx has provided you with a five-digit client number used to identify all of the activity regarding your account, pricing, contact information etc. It is located on the bottom of your monthly invoice. When contacting the finance department with questions regarding your account, please provide the finance staff with your client number and also include it on any cheques or other forms of payment. There are two (2) methods of payment. 1. Credit Card Debit

Visa, MasterCard and American Express are accepted and preferred. Your card will be charged for your monthly invoice total, 30 days after the invoiced date. A $20 administration fee is charged for credit cards declined for payment more than twice per month. To enroll in the Visa / MasterCard payment program, you must complete the “Authorization Form” provided on page 10-4 and fax to:

DynaLIFEDx ATTN: CLIENT SUPPORT

Secure Fax: (780) 454-2950

Once DynaLIFEDx has received your initial Authorization Form your information will be kept on file. Your monthly invoice will be mailed to your attention. 2. Money Order or Personal Cheque

Payment is due 30 days after the invoiced date. A $25 late fee is charged to invoices paid after the 30 day deadline.

Once you have reviewed your invoice, please mail your cheque payable to DynaLIFEDx to the address above. When paying with a money order or personal cheque, please include invoice number (located on the bottom of your monthly invoice) and your client account number on any cheques or other forms of payment. NSF cheques are subject to a $25 administration fee.




10.2 Naturopathic Doctor Invoicing

Each month around the 25th you will receive by mail a detailed invoice with all of the laboratory work performed from the previous month. If your account has a balance of zero dollars, an invoice will NOT be mailed to you. Please review your invoice carefully and notify the billing representatives at the address above of any discrepancies. A credit will be issued to your account in the case of a verified discrepancy.

All invoices are due upon receipt. All accounts 60 days overdue will be subject to review.

Refer to the sample invoice provided on page 10-3.

The Naturopathic Laboratory Testing Fee Schedule provides fees for all tests currently available at DynaLIFEDx.

10.3 Additional Test Access

All tests at DynaLIFEDx are currently available at fee for service, unless the specimen requirements are not suitable for distance collection. Only tests that appear on the Naturopathic Requisition are available for order and must be ordered in the way they appear on the requisition (individually or bundled with other tests in panels). Please direct queries regarding interest in additional tests, to your Provincial Association, for future consideration in expanding DynaLIFEDx Naturopathic Laboratory Test Menu.

10.4 Updating Account Information

It is important to ensure that DynaLIFEDx has your current account information on file at all times. To update any account information (i.e. change of address, phone and fax numbers, alternate locations of practice, credit card updates and adding/deleting Naturopathic physicians from your account), complete the “Change to Account Form” provided on page 10-5 and fax it to:

DynaLIFEDx

ATTN: CLIENT SUPPORT Secure Fax: (780) 454-2950

10.5 Account Inactivity

Accounts having no activity for a period of one year will be made INACTIVE without notification. To resume services and re-activate your account, there is a $75.00 fee.




*Complete pertinent section and sign and date the bottom of this form*

NAME OF CLINIC:

NAME OF EXISTING ACCOUNT HOLDER: Client # 60_______

�� Address Change. Effective date:

ADDRESS:

CITY: PROVINCE: POSTAL CODE:

TELEPHONE: ( ) FAX: ( )

EMAIL ADDRESS:

NAME(S) OF OFFICE CONTACT:

�� New Billing Information Below �� By signing below I authorize DynaLIFEDx to charge my credit card, for laboratory services provided to me and anyone I have added to my account. I understand that it is my responsibility to ensure that the charges can be applied 30 days after the invoiced date. I further agree that in the event my credit card becomes invalid or is declined twice for payment, I will provide DynaLIFEDx with payment of any outstanding balances and associated fees.

CREDIT CARD INFORMATION

Card Type: � VISA � MasterCard

Card Number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Expiry Date: __ __ / __ __

Name of Cardholder:

Authorized Signature: Date:

Address of Cardholder:

Phone Number:

�� Add this Naturopath to existing account; no changes to Billing Information. By signing this form, you agree that this Naturopath may be added to your billing account and that you will be responsible for all laboratory charges occurred by yourself or anyone added to your account.

NAME OF NATUROPATH:

TELEPHONE: ( ) FAX: ( )

EMAIL ADDRESS:

EMERGENCY CONTACT TELEPHONE NUMBERS: (at least one number must be provided for contact in case of Critical Laboratory Results)

HOME: ( ) CELL: ( )

PAGER: ( )

�� Delete this Naturopath from this account. Effective date:

NAME OF NATUROPATH:

�� Close this account. Effective date:

Account Holder Signature Date dd/mon/yyyy

FAX COMPLETED FORM TO DynaLIFEDx @ 780-454-2950

NATUROPATHIC LABORATORY TESTING CLIENT CHANGE TO ACCOUNT FORM

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