Laboratory Accession Log Form
Log and track laboratory sample intake efficiently. Please complete all required fields for each specimen.
Accession Number
*
Sample Identification Code
*
Date and Time of Receipt
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Specimen Type
*
Please Select
Blood
Urine
Tissue
Saliva
Swab
Other
Specimen Source/Origin
*
Received By (Staff Name)
*
Test(s) Requested
*
Condition of Specimen Upon Receipt
*
Please Select
Acceptable
Hemolyzed
Clotted
Insufficient Volume
Leaking
Other
Storage Location
Current Status / Remarks
Submit Log Entry
Should be Empty: