Pathology Specimen Tracking Log Form
Log and track pathology specimens as they move through the workflow. Complete all fields for each specimen entry.
Specimen Identifier
*
Patient Reference Code (Internal Use Only)
*
Specimen Type
*
Please Select
Blood
Tissue
Urine
Fluid
Swab
Sputum
Cytology Sample
Other
Collection Date and Time
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Collection Location
*
Received Date and Time
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Current Tracking Status
*
Please Select
Collected
In Transit
Received
Processing
Completed
On Hold
Other
Specimen Condition on Receipt
*
Please Select
Acceptable
Damaged
Leaking
Contaminated
Insufficient Volume
Mislabeled
Other
Processor/Handler Name
*
Notes or Comments
Submit
Should be Empty: