Dietary Restrictions & Home Collection Stool for Occult Blood Testing
Dear Patient, Your doctor has ordered a laboratory test for the detection of blood in your stool. In order for the test to be accurate you need to take the following precautions:

Medications: • For seven days before and during the stool collection period, avoid non-steroidal anti-inflammatory medications such as Motrin, Advil, naproxen or aspirin. Tylenol may be taken as needed. • For three days before and during the stool collection period avoid vitamin C in excess of 250 mg per day from supplements, and citrus fruits and juices. The recommended daily allowance for vitamin C is 60 mg per day. Foods: • For three days before and during the stool collection period avoid red meats (beef, lamb, and liver) • Eat a well balanced diet including fiber such as bran cereals, fruits and vegetables.

You need to collect a small sample of stool and place it on the cards that were provided to you. Your doctor may have requested you collect a single sample or multiple samples. 1. You may collect a sample in any clean, dry, disposable container. It is acceptable to collect a sample on to a sheet of newspaper placed under the seat but over the water. If you use toilet bowl cleaners that stay in the tank, remove the toilet bowl cleaner from the tank and flush twice before collecting a sample. 2. Using the small stick provided transfer a thin smear of stool sample to box A. Use the other end of the stick to place another thin smear of stool in box B (as shown in the picture). Close the cover and insert the tab under the flap to seal. 3. If you were given more than one card, repeat the collection on a different day for each of the remaining cards. 4. Be sure each card has your full name on it as well as the date and time of the stool collection. 5. Protect the cards from heat, light or household chemicals such as ammonia or bleach. After you have completed all the cards you were given, deliver them to any Clinical Laboratories of Hawaii site as soon as possible, and no later than 14 days after the first sample was collected. The sample is no longer good after 14 days and you will have to re-collect the samples. Be sure to bring the test request the doctor’s office gave you when you drop off the cards.

Form - 026 Effective Date: 05/01/06

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