NHA Labs + Clinical Tests
Clinical Laboratory Improvement Amendments (CLIA) - A 1988 amendment that regulates federal standards that apply to all clinical laboratory testing performed on humans in the United States
Clinical laboratory testing - Testing used in conjunction with health history and physical examination to provide essential data for the diagnosis and management of a patient’s condition.
CLIA-waived testing – includes blood glucose testing, urine pregnancy tests, rapid strep screening, etc
Urinalysis: Includes the physical, chemical, and microscopic examination of urine
Hematology: Blood cell counts that determine RBCs, WBCs, and platelets of a blood specimen
Chemistry: Chemicals found in blood, cerebrospinal fluid, urine, joint fluid, lipid profiles (such as triglycerides, total cholesterol, HDL, and LDL), and fasting glucose
Microbiology: Studying bacteria, fungi, parasites, yeasts, and viruses; specimens can include urine, blood, sputum, cerebrospinal fluid, stool, and wound material
Cytology: Microscope examination of cells for diagnostic purposes
Blood bank: Processes and stores blood and blood products for transfusion and blood disorder treatments
Requisition form information:
Patient name
Address
Date of birth
Sex
Telephone number
Insurance information
Provider information
Diagnosis code or indications for testing
Order date
Specimen labeling information:
Patient’s name
Patient’s date of birth
Date and time of collection
Medical assistant’s initials
Pregnancy testing: Urine is screened for the presence of human chorionic gonadotropin (hCG) antibodies.
Rapid strep testing: Throat swabs are obtained to screen for group A streptococcus.
Dipstick, tablet, or multi-stick urinalysis: The urinalysis is a screening tool for analytes that are excreted in the urine.
Hemoglobin: A machine is used to screen for the oxygen-carrying protein in whole blood, performed using capillary blood from a fingerstick (capillary puncture).
Spun hematocrit: Fingerstick collection of blood in microcapillary tubes is centrifuged and evaluated for the percentage of red blood cells.
Blood glucose: Whole blood is analyzed in a glucometer for a quantitative glucose level and is a screening test for diabetes, performed using capillary blood from a fingerstick (capillary puncture).
Hemoglobin A1C: This capillary blood test shows blood sugar control over an approximate 3-month period.
Cholesterol testing: Lipids are evaluated using capillary blood.
Helicobacter pylori: A blood sample screens for H. pylori, which is the main cause of gastric ulcers.
Mononucleosis screening: This screening tool tests for the presence of the Epstein-Barr virus in capillary blood.
Nasal smear for influenza types A and B: This screening is a qualitative test for influenza antigens using a swab that is inserted into the nostril.
Drug testing: Substances can be detected in urine and blood samples.
Fecal occult blood: This test is performed to screen for hidden blood in the stool.
Human chorionic gonadotropin (hCG) - Hormone secreted by the placenta during pregnancy.
Analytes - A substance or chemical that is being identified and measured.
Quantitative - Related to measuring the amount of something.
Qualitative - Identifying or measuring by the quality of something rather than its quantity.
Quality control: Action is performed to ensure the reliability of test results by detecting and eliminating error.
Quality assurance: Maintenance of a desired level of quality related to a service or piece of equipment.
Factors that could lead to false positive fecal occult blood tests:
Red meats
Red dye
Aspirin and associated products
Vitamin C supplements
Iron supplements
NORMAL LAB RESULTS
Recognize, Document, and Report Laboratory and Test Values
Laboratory Test | Specimen Type | Test Included | Reference Range/Results |
Hemoglobin (HGB) | Hematology Blood specimen | Hgb | Male: 13.5 to 17.5 g/dL Female: 12 to 16 g/dL |
Hematocrit (HCT) | Hematology Blood specimen | Hct | Male: 41% to 53% Female: 36% to 46% |
Complete Blood Count (CBC) | Hematology Blood specimen | White blood cell count | 4,500 to 11,000/mm3 |
Red blood cell count | Male: 4.5 to 5.9 million/mm3 Female: 4 to 5.5 million/mm3 | ||
Platelet count | 150,000 to 400,000/mm3 | ||
Granulocyte ratio | 50% to 70% (of all white blood cells) | ||
Hgb | (See above) | ||
Hct | (See above) | ||
MCV | A value score of 80 to 95 | ||
Glucose | Chemistry Blood specimen | Glucose | 70 to 100 mg/dL (fasting) |
Hemoglobin A1C | Hematology Blood | Hemoglobin A1C | Below 5.7% |
Cholesterol Cholesterol Panel/Lipid Profile | Chemistry Blood | Total Cholesterol | 130 to 200 mg/dL |
LDL | Less than 100 mg/dL | ||
HDL | Greater than 60 mg/dL | ||
Triglycerides | 40 to 150 mg/dL |
Preanalytical Phase
The provider orders a test to screen, monitor, or diagnose a patient’s condition.
A written or electronic requestion is filled out, showing the requested tests to be ordered, the specimen required, and where the specimen will be tested.
The specimen is collected, labeled, and processed.
The specimen is transported to the laboratory or properly prepared for offsite laboratory pickup.
Errors That Affect the Results
Inappropriate test request
Order entry error
Misidentification of the patient
Inappropriate container
Improperly labeling of specimen
Inadequate sample collection
Inadequate sample/anticoagulation ratio
Analytic Phase
Instruments are maintained and calibrated.
Controls are run and analyzed for each testing method.
The specimen is tested, and the results are compared with reference ranges.
The test results are logged and documented in the patient’s health record.
Errors That Affect the Results
Equipment malfunctions (Personnel are required to perform calibration on laboratory equipment. Preventive maintenance schedules must be followed and documented.)
Sample mix-up
Unindicated failure of quality controls
Procedures not properly followed
Postanalytical Phase
Specimens are properly discarded.
Analyses of control results are compared over time.
Patient reports from outside laboratories are logged or documented.
The provider interprets and signs all lab reports.
The patient is notified of the results in the office or is contacted by laboratory personnel.
The final report and all communication with the patient are documented in the patient’s health record.
Errors That Affect the Results
Failure to report
Improper data entry (Accurate recording is a key responsibility of the medical assistant.)
Excessive turnaround time
Specialty testing: Tests performed in the medical office that do not fall under point-of-care testing or CLIA-waived tests
Snellen chart: chart used to evaluate distance vision
Ishihara test: test used to assess for color deficiency (colorblindness)
Tympanometry: records the movement of tympanic membrane in order to assess for hearing loss
Normal tympanogram results: produces a peak on the graph
Abnormal tympanogram results: produce a flat line
To know: An adult who has normal hearing should be able to hear tones below 25 decibels, and a child should be able to hear below 15 decibels.
Scratch allergy test: A diluted allergen is applied to a scratch or prick that has been made on the surface of the patient’s skin. The testing is usually conducted on the forearm or upper back. If a wheal occurs in the first 15 minutes, the allergist can identify the substance as a possible allergen and consider further allergy testing to be conducted intradermally.
Intradermal allergy test: A diluted allergen is injected intradermally, and the patient is observed. An initial wheal is expected. If the wheal becomes inflamed with induration (raised, hard area), the substance can be identified and confirmed as an allergen.
Expected Values of Pulmonary Function Tests
Test | Expected Value (95% confidence interval) |
FEV1 | 80% to 120% |
FVC | 80% to 120% |
Absolute FEV1/FVC ratio | Within 5% of the predicted ratio |
TLC | 80% to 120% |
FRC | 75% to 120% |
RV | 75% to 120% |
Clinical Laboratory Improvement Amendments (CLIA) - A 1988 amendment that regulates federal standards that apply to all clinical laboratory testing performed on humans in the United States
Clinical laboratory testing - Testing used in conjunction with health history and physical examination to provide essential data for the diagnosis and management of a patient’s condition.
CLIA-waived testing – includes blood glucose testing, urine pregnancy tests, rapid strep screening, etc
Urinalysis: Includes the physical, chemical, and microscopic examination of urine
Hematology: Blood cell counts that determine RBCs, WBCs, and platelets of a blood specimen
Chemistry: Chemicals found in blood, cerebrospinal fluid, urine, joint fluid, lipid profiles (such as triglycerides, total cholesterol, HDL, and LDL), and fasting glucose
Microbiology: Studying bacteria, fungi, parasites, yeasts, and viruses; specimens can include urine, blood, sputum, cerebrospinal fluid, stool, and wound material
Cytology: Microscope examination of cells for diagnostic purposes
Blood bank: Processes and stores blood and blood products for transfusion and blood disorder treatments
Requisition form information:
Patient name
Address
Date of birth
Sex
Telephone number
Insurance information
Provider information
Diagnosis code or indications for testing
Order date
Specimen labeling information:
Patient’s name
Patient’s date of birth
Date and time of collection
Medical assistant’s initials
Pregnancy testing: Urine is screened for the presence of human chorionic gonadotropin (hCG) antibodies.
Rapid strep testing: Throat swabs are obtained to screen for group A streptococcus.
Dipstick, tablet, or multi-stick urinalysis: The urinalysis is a screening tool for analytes that are excreted in the urine.
Hemoglobin: A machine is used to screen for the oxygen-carrying protein in whole blood, performed using capillary blood from a fingerstick (capillary puncture).
Spun hematocrit: Fingerstick collection of blood in microcapillary tubes is centrifuged and evaluated for the percentage of red blood cells.
Blood glucose: Whole blood is analyzed in a glucometer for a quantitative glucose level and is a screening test for diabetes, performed using capillary blood from a fingerstick (capillary puncture).
Hemoglobin A1C: This capillary blood test shows blood sugar control over an approximate 3-month period.
Cholesterol testing: Lipids are evaluated using capillary blood.
Helicobacter pylori: A blood sample screens for H. pylori, which is the main cause of gastric ulcers.
Mononucleosis screening: This screening tool tests for the presence of the Epstein-Barr virus in capillary blood.
Nasal smear for influenza types A and B: This screening is a qualitative test for influenza antigens using a swab that is inserted into the nostril.
Drug testing: Substances can be detected in urine and blood samples.
Fecal occult blood: This test is performed to screen for hidden blood in the stool.
Human chorionic gonadotropin (hCG) - Hormone secreted by the placenta during pregnancy.
Analytes - A substance or chemical that is being identified and measured.
Quantitative - Related to measuring the amount of something.
Qualitative - Identifying or measuring by the quality of something rather than its quantity.
Quality control: Action is performed to ensure the reliability of test results by detecting and eliminating error.
Quality assurance: Maintenance of a desired level of quality related to a service or piece of equipment.
Factors that could lead to false positive fecal occult blood tests:
Red meats
Red dye
Aspirin and associated products
Vitamin C supplements
Iron supplements
NORMAL LAB RESULTS
Recognize, Document, and Report Laboratory and Test Values
Laboratory Test | Specimen Type | Test Included | Reference Range/Results |
Hemoglobin (HGB) | Hematology Blood specimen | Hgb | Male: 13.5 to 17.5 g/dL Female: 12 to 16 g/dL |
Hematocrit (HCT) | Hematology Blood specimen | Hct | Male: 41% to 53% Female: 36% to 46% |
Complete Blood Count (CBC) | Hematology Blood specimen | White blood cell count | 4,500 to 11,000/mm3 |
Red blood cell count | Male: 4.5 to 5.9 million/mm3 Female: 4 to 5.5 million/mm3 | ||
Platelet count | 150,000 to 400,000/mm3 | ||
Granulocyte ratio | 50% to 70% (of all white blood cells) | ||
Hgb | (See above) | ||
Hct | (See above) | ||
MCV | A value score of 80 to 95 | ||
Glucose | Chemistry Blood specimen | Glucose | 70 to 100 mg/dL (fasting) |
Hemoglobin A1C | Hematology Blood | Hemoglobin A1C | Below 5.7% |
Cholesterol Cholesterol Panel/Lipid Profile | Chemistry Blood | Total Cholesterol | 130 to 200 mg/dL |
LDL | Less than 100 mg/dL | ||
HDL | Greater than 60 mg/dL | ||
Triglycerides | 40 to 150 mg/dL |
Preanalytical Phase
The provider orders a test to screen, monitor, or diagnose a patient’s condition.
A written or electronic requestion is filled out, showing the requested tests to be ordered, the specimen required, and where the specimen will be tested.
The specimen is collected, labeled, and processed.
The specimen is transported to the laboratory or properly prepared for offsite laboratory pickup.
Errors That Affect the Results
Inappropriate test request
Order entry error
Misidentification of the patient
Inappropriate container
Improperly labeling of specimen
Inadequate sample collection
Inadequate sample/anticoagulation ratio
Analytic Phase
Instruments are maintained and calibrated.
Controls are run and analyzed for each testing method.
The specimen is tested, and the results are compared with reference ranges.
The test results are logged and documented in the patient’s health record.
Errors That Affect the Results
Equipment malfunctions (Personnel are required to perform calibration on laboratory equipment. Preventive maintenance schedules must be followed and documented.)
Sample mix-up
Unindicated failure of quality controls
Procedures not properly followed
Postanalytical Phase
Specimens are properly discarded.
Analyses of control results are compared over time.
Patient reports from outside laboratories are logged or documented.
The provider interprets and signs all lab reports.
The patient is notified of the results in the office or is contacted by laboratory personnel.
The final report and all communication with the patient are documented in the patient’s health record.
Errors That Affect the Results
Failure to report
Improper data entry (Accurate recording is a key responsibility of the medical assistant.)
Excessive turnaround time
Specialty testing: Tests performed in the medical office that do not fall under point-of-care testing or CLIA-waived tests
Snellen chart: chart used to evaluate distance vision
Ishihara test: test used to assess for color deficiency (colorblindness)
Tympanometry: records the movement of tympanic membrane in order to assess for hearing loss
Normal tympanogram results: produces a peak on the graph
Abnormal tympanogram results: produce a flat line
To know: An adult who has normal hearing should be able to hear tones below 25 decibels, and a child should be able to hear below 15 decibels.
Scratch allergy test: A diluted allergen is applied to a scratch or prick that has been made on the surface of the patient’s skin. The testing is usually conducted on the forearm or upper back. If a wheal occurs in the first 15 minutes, the allergist can identify the substance as a possible allergen and consider further allergy testing to be conducted intradermally.
Intradermal allergy test: A diluted allergen is injected intradermally, and the patient is observed. An initial wheal is expected. If the wheal becomes inflamed with induration (raised, hard area), the substance can be identified and confirmed as an allergen.
Expected Values of Pulmonary Function Tests
Test | Expected Value (95% confidence interval) |
FEV1 | 80% to 120% |
FVC | 80% to 120% |
Absolute FEV1/FVC ratio | Within 5% of the predicted ratio |
TLC | 80% to 120% |
FRC | 75% to 120% |
RV | 75% to 120% |
