CMPT -Enteric Parasitology Identification Survey Results

Please complete this form using the code tables on the reverse side. Page 1 of 2

Spec no. Concentrate Stain Code:
Parasite Name Code Quantitation Other Findings
    Helminth Protozoa  
    Ova Larva Troph Cyst  
             
             
             
             
             
Comments:
Spec no. Concentrate Stain Code:
Parasite Name Code Quantitation Other Findings
    Helminth Protozoa  
    Ova Larva Troph Cyst  
             
             
             
             
             
Comments:
Spec no. Concentrate Stain Code:
Parasite Name Code Quantitation Other Findings
    Helminth Protozoa  
    Ova Larva Troph Cyst  
             
             
             
             
             
Comments:
   
Spec no. Concentrate Stain Code:
Parasite Name Code Quantitation Other Findings
    Helminth Protozoa  
    Ova Larva Troph Cyst  
             
             
             
             
             
Comments:
Spec no. Concentrate Stain Code:
Parasite Name Code Quantitation Other Findings
    Helminth Protozoa  
    Ova Larva Troph Cyst  
             
             
             
             
             
Comments:
 
Spec no. Concentrate Stain Code:
Parasite Name Code Quantitation Other Findings
    Helminth Protozoa  
    Ova Larva Troph Cyst  
             
             
             
             
             
Comments:
________________________________________________    ___________
                                   Laboratory                                                                          Lab No.		       ___________________       ____________________________
             Date Reported                                                Signature
The following tables provide the codes to facilitate completion of the results reporting tables   Page 2 of 2
If the parasite name and parasite code do not match, the name will be taken as the intended response, and the discrepancy will be noted
Staning Codes S Helminths   Protozoa   Other  
Concentrate with saline mount 1 Ascaris lumbricoides H1 Acanthamoeba species P1 Charcot-Leyden Crystals O1
Concentrate with iodine 2 Clonorchis sinensis H2 Balantidium coli P2 Leukocytes (Pus Cells) O2
Trichrome 3 Dicrocoelium dentriticum H3 Blastocystis hominis P3 Other (please specify) O3
Iron Hematoxylin 4 Diphyllobothrium latum H4 Cryptosporidium parvum P4 .  
Kinyoun's modified acid fast 5 Dipylidium caninum H5 Cyclospora cayetanensis P5 .  
Sequential Haematoxylin/acid fast 6 Echinostoma species H6 Dientamoeba fragilis P6 .  
Sequential Trichrome/acid fast 7 Enterobius vermicularis H7 Endolimax nana P7 .  
Other (please specify) 8 Fasciolopsis buski H8 Entamoeba coli P8 .  
    Heterophyes heterophyes H9 Entamoeba coli P9 .  
    Hookworm H10 Entamoeba hartmanni P10 .  
Quantitation Codes Hymenolepis diminuta H11 Entamoeba histolytica P11 .  
Concentrate Hymenolepis nana H12 Entamoeba polecki P12 .  
1+    Few     <11 per 22mm x 22mm coverslip Metagonimus yokogawai H13 Enteromonas hominis P13 .  
2+    Mod     11 - 20 per 22mm x 22mm coverslip Metorchis conjunctus H14 Giardia lamblia P14 .  
3+    Many    >20 per 22mm x 22mm coverslip Paragonimus westermani H15 Iodamoeba bütschlii P15 .  
Stained Smear Schistosoma haematobium H16 Isospora belli P16 .  
1+   Few     <2 per 10 oil immersion fields (x1000) Schistosoma japonicum H17 Sarcocystis hominis P17 .  
2+   Mod      3-9 per 10 oil immersion fields (x1000) Schistosoma mansoni H18 Retortamonas intestinalis P18 .  
3+   Many    >10 per 10 oil immersion fields (x1000) Strongyloides stercoralis H19 Trichomonas hominis P19 .  
  Taenia species H20 Trichomonas vaginalis P20 .  
Please note that quantitation is requested as an Taenia saginata H21 Other protozoa (please list) P21 .  
Internal check system for sample consistency Taenia solium H22 . . .  
& is not used as part of laboratory assessment Trichostrongylus species H23 . . .  
  Trichuris trichiura H24 . . .  
  Other helminths (please list) H25 . . .  
Please note: This Print from Screen report form may be printed and used to submit results to CMPT via faxing completed forms to 604-875-4100. (This form may not print as a single page - it depends on your browser.)