Microsoft word - jetti katz tropical medicine lab form.doc
JETTI KATZ TROPICAL MEDICINE LAB
TEST REQUISITION AND PRICE LIST
Patient Name:________________________________ Purged:
Routine O/P Stool: Macroscopic and microscopy exam of stool for
routine Protozoa and all Helminths, plus Entamoeba Histolytica Stool Antigen by E.I.A. and Giardia Stool Antigen by E.I.A.
Panel 1 Stool Test: Includes all test in the ruotine O/P Tests plus adds
Cyclospora, Isospora Belli, Bacterial Culture and Sensitivity, and Clostridia Difficile Toxins A & B by E.I.A.
Panel 2 Stool Test: Macroscopic and microscopy exam of stool for all
Protozoa including Cyclospora, Isospora Belli and Microsporidium, all Helminths: Entamoeba Histolytica Stool Antigen by E.I.A., Giardia Stool Antigen by E.I.A. and Cryptosporidium Stool Antigen by E.I.A.
For all Bloody Stool: Shigella, E. Coli 0157:H7, Shiga Toxin-
Producing non 0157:H7 E. Coli, E. Histolytica Stool Antigen and Clostridia Difficile
Toxins A & B all of the above by E.I.A. INDIVIDUAL TESTS:
E. Coli 0157:H7 by
Yeast Culture (Candida
Cryptosporidium by E.I.A.
Sudan Fat Stain
Clostridium difficile Toxin
A&B by E.I.A.
Specimen I.D. Worms
Arthropods, Debris or Food Particles
Bacterial Stool Culture and
Mycobacterium T.B. or MAI
(Mycrobacterium Avium Intracellulare)
Pinworm (by Scotch tape
*please contact us by email firstname.lastname@example.org, by telephone 212.207.4923, or
U.S. mail to have a kit sent to you.
$15 will be added to your bill for the U.P.S. charge and kits can only be sent to a
street address not a PO box.
Jetti Katz Lab has a highly experienced infectious disease physician on staff. Dr.
Asher has 35 years of experience in parasitology. When you call our lab with your
referral form from our web page, Dr. Asher will help you decide which tests you
need to have performed.
If your tests are positive and you do not have a physician or would rather use Dr.
Asher, consultations are available for diagnosis & treatment.
In-office consultations will be $500 plus testing, phone consultations are $300, plus
testing. (in which case our kits for testing will be sent to you.)
All fees including the mailing fee of $15 and the initial $100 for the doctor must be
paid by a valid credit card submitted with the kit specimens.
INSTRUCTIONS FOR THE PATIENT
1. Do not take antibiotics or anti parasitic medication for 2 weeks prior
to testing (e.g.: Sulfa, Tetracycline, erythromycin, Flagyl, Humatin, Yodoxin) unless your physician specifically recommends differently.
2. Do not take any tablet or liquid antacids (Maalox, Mylanta, Gelusil,
Tums, Amphogel, Tagamet, Axid, Zantac or Pepsid) or antidiarrheal medicine (Kaopecate, Pepto Bismol, Immodium, Lomotil) for 24 hours prior to test.
3. The entire fee is payable at the time of test (check, cash and credit
cards accepted). We will give you receipt to submit to your insurance for reimbursement. Medicare not Accepted and CANNOT be submitted.
4. We are a testing laboratory. Only physician is qualified to answer
your questions about symptoms, diagnosis and treatment.
5. N.Y. State law specifically prohibits labs from giving resultsnto
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