CELLULAR PATHOLOGY DEPARTMENT
                   ANDROLOGY

PATIENT INFORMATION SHEET - COLLECTION AND TRANSPORT OF SEMEN FOR POST VASECTOMY SEMEN ANALYSIS

1.

The patient should abstain from sex or masturbation for at least two days prior to producing the specimen.

2.

The specimen should be obtained by masturbation.

3.

The entire specimen should be collected directly into the container provided.  A sheath must not be used for collection of the specimen.

4.

The specimen container should be securely fastened and clearly labelled with the date and time of collection and the patient’s name.

5.

The specimen must be placed in a plastic bag along with the completed section at the lower part of this form and a request form signed by the doctor.

6.

Specimens must not be sent by post. Specimens should reach the Cellular Pathology Department at Basildon Hospital within three hours of collection, Monday to Friday only between 08:30 and 16:00 hours. 

7.

If more convenient, specimens may be taken to Pathology at Orsett Hospital, but this should be before 12:00 hrs. so that the specimen may be transported to Basildon Hospital in reasonable time.

8.

A reliable report cannot be guaranteed if the above instructions are not observed.

10.

Under no circumstances will the report be given to anyone other than the requesting doctor.

If your require further information please telephone 01268 598212

  

PLEASE COMPLETE AND SEND WITH SPECIMEN

Full Name  ___________________________________________________

Date of Birth  ___ / ___ / ______

GP / Consultant  __________________________________

Date and Time of Specimen Collection  __________________________________

Date of Vasectomy  ___ / ___ / ______

I certify that I have read and followed the above instructions

Patient's Signature  _____________________________________________

Last edited 07/08/08