Instructions For Collecting And Shipping FTA® Card Samples
Customer Service (Toll Free): 877-4-RITUXIMAB (877-474-8894)

1. When you receive your sample collection kit, complete the Test Requisition and informed Consent. Review all forms with the patient. Keep a signed copy of the informed Consent for your records and give a copy to the patient. Fax both completed forms along with a copy of the front and back of the patient’s insurance card(s), and a written prescription for the specific test you are ordering. Fax to 919-466-9675.
   
   
2. before obtaining the sample, write the patient’s initials and date of birth on the FTA® card. Place a peelable bar code label on the FTA® Classic Card (a second peelable bar code label may be placed on the Medicare ABN Form, if applicable).
   
   
3. Complete the sample collection as outlined below using the lancet and FTA® Card provided:
   
   
   • After cleaning the pad of the ring finger of the nondominant hand with an alcohol wipe, PULL OFF yellow indicator from lancet as directed on tab and place in disposal.
     
     
   • Position safety lancet firmly against puncture site. Hold lancet between fingers and place thumb on white activation button.
     
     
   • To activate, press white activation button firmly into colored housing. Button will lock into housing and will not recoil. Do not pull lancet away from puncture site until after activation.
     
     
   • Gently massage from base of finger to near the puncture site, holding hand below elbow level to obtain the required blood volume. apply blood to all 4 sample areas of the FTA® Card if possible.
     
     
   • Allow samples to air dry for 20 minutes and then place in white multi-barrier pouch.

Send to PGxHealth in Infecon Bag:

• FTA® Pouch with FTA® Card
• Dessicant
• Medicare ABN Form, if applicable
• Test Requisition *Samples returned without Test Requisition Sheet will NOT BE PROCESSED*

Blank FTA® Classic Card. Place bar code with patient’s initials and date of birth on the bottom of the card. Fill all four spots with blood from the patient.

Affix preprinted billable stamp to the top of the shipping container. Ship on the day of sample collection to:

PGxHEALTH, a division of CLINICAL DATA, INC.
ATTN: RITUXIMAB
100 Perimeter Park Drive, Suite C.
Morrisville, NC 27560

1-877-2-PGXHEALTH (877-274-9432)