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Quick and Easy Colorectal Cancer Screening at Home Protect yourself from colorectal cancer. This is your Fecal Immunochemical Test or FIT kit—a quick and easy way to test for colorectal cancer at home. When should you do this test? You can do this test the next time you have a bowel movement (“poop”). But if there’s any blood when you have a bowel movement, please wait until the bleeding has stopped to do this test. For a video demonstration of how to use this kit, please go to kpdoc.org/FITvideo. If you have questions, call the Kaiser Permanente Appointment and Advice line at 1-866-454-8855. Step 1. Collect a sample What’s in this kit? NO POSTAGE NECESSARY IF MAILED IN THE UNITED STATES FROM: TIME SENSETIVE Exempt Human Specimen FIRST-CLASS MAIL PERMIT NO. 302 EL CERRITO CA POSTAGE WILL BE PAID BY ADDRESSEE TPMG REGIONAL LABORATORY P O BOX 899 EL CERRITO CA 94530-9899 BUSINESS REPLY MAIL BIOHAZARD ORDERING PHYSICIAN LAB ID # Large collection tissue paper (folded) Sample bottle and stick Small shipping pad Plastic biohazard bag Instruction sheet Return envelope FOBT-CHEK Is a registered trademark of Polymedco, Inc. ORDERING PHYSICIAN LAB ID # ORDERING PHYSICIAN LAB ID # 1. Unfold the collection paper. 5. Push the stick back into the sample bottle until the cap clicks. (Collection paper will flush easily.) 4. Poke the stool (“poop”) with the sample stick a few times to cover the grooved tip of the stick. FOBT-CHEK Is a registered trademark of Polymedco, Inc. ORDERING PHYSICIAN LAB ID # ORDERING PHYSICIAN LAB ID # 3. Twist and lift the cap on the sample bottle. Keep the liquid in the bottle. We need it for the test. 2. Lay the collection paper flat inside your toilet on top of the water. Have a bowel movement on top of the paper. CLICK!

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Quick and Easy Colorectal Cancer Screening at Home

Protect yourself from colorectal cancer. This is your Fecal Immunochemical Test or FIT kit—a quick and easy way to test for colorectal cancer at home.

When should you do this test?You can do this test the next time you have a bowel movement (“poop”). But if there’s any blood when you have a bowel movement, please wait until the bleeding has stopped to do this test.

For a video demonstration of how to use this kit, please go to kpdoc.org/FITvideo. If you have questions, call the Kaiser Permanente Appointment and Advice line at 1-866-454-8855.

Step 1. Collect a sample

What’s in this kit?NO POSTAGENECESSARYIF MAILED

IN THEUNITED STATES

FROM:

T IME SENSE TIVEExempt Human Specimen

FIRST-CLASS MAIL PERMIT NO. 302 EL CERRITO CA

POSTAGE WILL BE PAID BY ADDRESSEE

TPMG REGIONAL LABORATORYP O BOX 899EL CERRITO CA 94530-9899

BUSINESS REPLY MAIL

B I O H A Z A R D

FOBT-C

HEK

Is a registered

tradem

ark of Po

lymed

co, Inc.

ORDERING PHYSICIAN LAB ID #

Large collection tissue paper (folded)

Sample bottle and stick

Small shipping pad

Plastic biohazard bag

Instruction sheet

Return envelope

FOBT-C

HEK

Is a registered

tradem

ark of Po

lymed

co, Inc.

ORDERING PHYSICIAN LAB ID #ORDERING PHYSICIAN LAB ID #

1. Unfold the collection paper.

5. Push the stick back into the sample bottle until the cap clicks. (Collection paper will flush easily.)

4. Poke the stool (“poop”) with the sample stick a few times to cover the grooved tip of the stick.

FOBT-CHEK Is a registered trademark of Polym

edco, Inc.

ORDERING PHYSICIAN LAB ID #

ORDERING PHYSICIAN LAB ID #

3. Twist and lift the cap on the sample bottle. Keep the liquid in the bottle. We need it for the test.

2. Lay the collection paper flat inside your toilet on top of the water. Have a bowel movement on top of the paper.

CLICK!

© 2013, TPMG, Inc. All rights reserved. Regional Health Education.011061-376 (Revised 7/17) RL 5.6

Step 2. Label your sample

Step 3. Prepare your package for mailing

For Staff Use

Please mail your stool sample back within 48 hours of collection.

Ordering provider lab ID#

Provider name

X RILIS mnemonic: FIT [fecal Hemoglobin] Inreach

Place Patient Visit Label (PVL) here:

[ ]

2. If not alreadydone, write yourname, medicalrecord number,and collectiondate on thesample bottlelabel.

3. Foldthis sheetand put itin the returnenvelope.

FOBT-C

HEK

Is a registered

tradem

ark of Po

lymed

co, Inc.

ORDERING PHYSICIAN LAB ID #

1. Wrapyour samplebottle inthe smallshipping pad.

FOBT-C

HEK Is a registered tradem

ark of Polymedco, Inc.

ORDERING PHYSICIAN LAB ID #

B I O H A Z A R D

2. Put thesample bottleand the padinside theplasticbiohazardbag. Sealthe bag.

4. Check thatyou’ve included:

• Sample bottle• Shipping pad• Biohazard bag• This sheet

FOBT-C

HEK Is a registered tradem

ark of Polymedco, Inc.

ORDERING PHYSICIAN LAB ID #

B I O H A Z A R D

Instructions: 1. Collect stool per sample collection instructions.2. Remove plastic bag and absorbent pad from envelope.3. Wrap sampling bottle in absorbent pad and insert into plastic bag.4. Insert plastic bag with sampling bottle and absorbent pad into envelope.5. Peel tape from flap.6. Fold flap at prefold line.7. Press firmly to seal.8. Return to your doctor or laboratory.

40148-KPB-04

1. In ballpointpen, fill in theyellow boxat the right.Collectiondate is the dateyou collectedyour sample.

US MAIL

NO POSTAGENECESSARYIF MAILED IN THE

UNITED STATES

FROM:

T IME SENSET IVE

Exempt Human Specimen

FIRST-CLASS MAIL

PERMIT NO. 302

EL CERRITO CA

POSTAGE WILL BE PAID BY ADDRESSEE

TPMG REGIONAL LABORATORY

P O BOX 899

EL CERRITO CA 94530-9899

BUSINESS REPLY MAIL

NO POSTAGENECESSARY

IF MAILED IN THE

UNITED STATESFROM:

T IME SENSE TIVEExempt Human Specimen

FIRST-CLASS MAIL PERMIT NO. 302 EL CERRITO CA

POSTAGE WILL BE PAID BY ADDRESSEE

TPMG REGIONAL LABORATORY

P O BOX 899

EL CERRITO CA 94530-9899

BUSINESS REPLY MAIL

5. Mail the envelope within 48 hours.

FOBT-C

HEK

Is a registered

tradem

ark of Po

lymed

co, Inc.

ORDERING PHYSICIAN LAB ID #PATIENT NAME

MEDICAL RECORD NUMBER

COLLECTION DATE