CONCEPT #80 OF 100 · Medical, Dental & Clinical Practices · LAYOUT: asymmetric_sidebar
CLIA High-Complexity Clinical Diagnostic Pathology Report & Critical Value Log
Standard / Reference: 42 C.F.R. Part 493 (CLIA '88 High-Complexity Standards) · CAP Laboratory Accreditation
Why professionals use this template: 15,200/mo search demand: clinical and anatomic pathology laboratories generating physician reports with CLIA/CAP numbers, reference intervals, abnormal flags, and critical value read-back logs.
144-DPI VECTOR PREVIEW · PAGE 1 OF 1
ACROFORM READY
Included Financial Metrics & Line-Item Schedule
Target Roles: Board-Certified Pathologists, CLIA Lab Directors & Molecular Reference Labs · Search Keywords: clia clinical diagnostic pathology report template pdf, histopathology surgical pathology report form, clia 42 cfr 493 critical value callback log, cap accredited molecular lab report
CLIA / CAP ID
44D209418 · CAP #7189201
SPECIMEN INTEGRITY
EDTA Whole Blood (Hemolysis 0)
CRITICAL VALUE ALERT
PLT 68 k/uL (Phoned 10:14 AM)
TURNAROUND TIME (TAT)
3.8 Hours (STAT Priority)
| CODE | DESCRIPTION & TECHNICAL SPECIFICATION | BASIS / QTY | AMOUNT / DELTA |
|---|---|---|---|
| CBC-WBC | White Blood Cell Count (Automated 5-Part Flow Cytometry Differential) | Ref: 4.5–11.0 k/uL | 14.2 k/uL [HIGH] |
| CBC-HGB | Hemoglobin Quantitative Photometric Concentration (Venous Whole Blood) | Ref: 13.5–17.5 g/dL | 11.4 g/dL [LOW] |
| CBC-PLT | Platelet Count Automated Impedance + Optical Re-Check (CRITICAL LOW) | Ref: 150–450 k/uL | 68 k/uL [CRIT] |
| CMP-TROP | High-Sensitivity Cardiac Troponin-I (hs-cTnI Chemiluminescent Immunoassay) | Ref: < 14.0 ng/L | 9.2 ng/L [NORM] |
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