The Cornea/Eye protocol outlines the process of sending cornea or eye specimens to the Oculopathology Laboratory at the University of Iowa Hospitals and Clinics or UW Madison Eye Pathology Laboratory.
1. A Specimen Transfer sheet from surgery will be marked to send to (or other specified physician and institution):
F.C. Blodi Eye Pathology Laboratory
Department of Opthamology & Visual Sciences
233 Medical Research Center
Iowa City IA 52242-1182
Phone: (319) 335-7095; FAX: (319) 335-7193
UW Eye Pathology Laboratory
600 Highland Ave F4/378 CSC
Madison WI 53792-3220
Phone: (608) 263-1474; FAX: (608) 263-0543 Attn: Vicky
Note: UW Eye Pathology Laboratory provide kits, which include all supplies needed.
2. A copy of the patient’s history and physical must accompany the specimen.
Note: This accompanies the specimen from surgery.
3. Assign the cornea specimens a surgical number, using the Referred Surgical Consult specimen class (S-CO), the number wheel RCO will display as default.
4. Corneas are sent in the container in which they were received.
A. Label the vial with the patient’s name and demographic information.
B. Verify that a 10% formalin sticker has been applied to the container.
C. Wrap Parafilm around the cap of the container to prevent leakage.
5. Prepare for shipment:
A. Complete a Return Address label and place it on the appropriate shipping container.
B. Place the container in a plastic zip-lock bag padded with absorbent material and seal the bag.
a. University of Wisconsin:
1. Place the sealed bag containing the specimen into a mailing tube.
2. Include the following completed forms:
Patient insurance information form
“Clinical Laboratories Surgical Path” form.
Note: Specify the surgeons name as the referring physician. Under the “Other Phy. Needing Report” section fill in the name of the pathologist on the bench and FAX # (563) 589-8605.
3. UW provides prepaid packaging with shipment via UPS.
Note: Any shipments by UPS must be taken to the UPS/receiving counter located in the Mercy basement.
b. University of Iowa:
1. Obtain a biohazard tube/container from the hospital supply dept and place the sealed bag into the container.
2. Include the Ocular Pathology Consult Request form
Note: Complete the form, include:
Tissue Submitted: check either “OD” (right) or “OS” (left)
Referring Provider: Surgeon:
Referring Institution: United Clinical Labs and specify the site
3. Place the mailing tube into another biohazard bag and then place this into the shipping envelope.
4. Send the shipping envelope via CDS, if after 2 P.M. ship by FedEx, using the preprinted UIHC forms. Refer to the “Transport of Specimens to UHL/UIDL” procedure.
6. Record the cornea referral in the slide send out (S.S.O.) function of CoPath. Use a “return” date of 30 days out, to allow for report tracking.
7. When the Oculopathology Report is returned record the date returned in the S.S.O. and distribute report copies as follows:
A. Original to scan into report gallery
B. Copy to patient chart (Mercy Medical Records)
C. Copy to referring physician
Note: It is not necessary for the pathologist to review the report.
i. March 2007 N. Schmitt
ii. May 2010 B. Wederquist (Revised: II. for UI and UW specifics)
Interim Review: August 2011 K. Kalish (Revised: II.5.B.b.4.)