quick and easy colorectal cancer screening at home kit in reach... · quick and easy colorectal...
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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