USC Oral Health Center

Center for Oral Microbiology Testing
OMTL Checklist ( printable version)

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Checklist for Sending OMTL Specimens

FILL OUT THE LAB REQUISITION FORM COMPLETELY

Include the following: (see attached sheet)

_____ 1) Date
_____ 2) Subscriber Information **see Note below**
_____ 3) Patient Information
_____ 4) Indicate Tests Required.

The "Selective Periodontal Pathogen Culture and DNA Probe Analysis" (includes testing for antimicrobials)

_____ 5) Sample sites, times and date collected.
_____ 6) Any notes can be written and circled, such as "patient is allergic to penicillin, etc."
_____ 7) Fees:

* One sample includes selective periodontal pathogen culture (1 transport media vial) = $105.00
(1 transport media vial + 1 DNA probe vial, whether from pooled or a single site + sensitivity) = $145.00

* The 2nd sample and each additional sample on the same patient, whether taken at the same time from another site or retest taken within 6 months for selective periodontal pathogen culture = $60.00

2nd sample and each additional sample on same patient or retest within 6 months for patient for selective periodontal pathogen culture + DNA analysis + sensitivity = $85.00

** NOTE: Your account number will appear on all lab reports sent by OMTL.
(Please be sure to include your subscriber/account number in your subscriber information)

SENDING THE SAMPLE

_____ 1) Label vials with the patient name
_____ 2) Place each set of 2 vials (1 transport media vial + 1 plastic centrifugal vial) in the white mailing container
_____ 3) Place the mailing container in the padded brown envelope
_____ 4) Send the sample to the lab by using an overnight service (Federal Express, Express Mail, Airbourne, UPS, etc.)

IF THE PATIENT HAS BEEN ON ANTIBIOTICS, IT IS USUALLY ADVISABLE TO WAIT 6-8 WEEKS BEFORE OBTAINING A SPECIMEN FOR MICROBIOLOGY CULTURE.