Quick and Easy Colorectal Cancer Screening at Home

Quick and Easy Colon Cancer Screening at Home

Protect yourself from colon cancer. This is your fecal immunochemical test or FIT kit to test for colon 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.

What's in this kit?

Large collection tissue paper (folded)

Sample bottle and stick

Small shipping pad

Collection Date

/

/

BIOHAZARD

Plastic biohazard bag

Instruction sheet

FROM:

Exempt Human Specimen TIME SENSETIVE

NO POSTAGE NECESSARY IF MAILED

IN THE UNITED STATES

BUSINESS REPLY MAIL

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

Return envelope

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

Step 1. Collect a sample

1. Unfold the collection paper.

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

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

MM / DD /YYYY Collection Date

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

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

CLICK!

/

MM DD / Collection YYYY Date

Date and include this entire page in return envelope.

Write the collection date on the bottle and BELOW. The collection date is the date you collected your sample:

/

MM

DD

/ YY YY

Step 2. Label your sample

If not already done, write your name, medical record number, and collection date on the sample bottle. Remember to check the expiration date on the sample bottle. If the date has expired, don't use this kit and call 1-866-454-8855 to request a new one.

MM / DD / YYYY

Collection Date

Step 3. Prepare your package for mailing

1. Wrap your sample bottle in the small shipping pad.

ORDERING PHYSICIAN LAB ID # FOBT-CHEK Is a registered trademark of Polymedco, Inc.

2. Put the sample bottle and the pad inside the plastic biohazard bag and seal it.

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ORDERI FOBT-CHEK

BIOHAZARD

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3. Fold the instruction sheet and put in return envelope.

4. Check that you've included:

? Sample bottle and instruction sheet with collection date

? Shipping pad and biohazard bag

FOORBTD-CEHERKINIs aGrePgiHsteYreSdItCradIAemNarkLoAf PBolyImDed#co, Inc.

B I O H A Z A R D 40148-KPB-04

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.

5. Mail the envelope within 24 hours of collecting your

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FROM:

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Specimen ENSE

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BUSINESS REPLY MAIL FIRST-CLASS

MAIL POSTAGE

PERMIT NO. 302 WILL BE PAID BY

EL CERRITO ADDRESSEE

CA

TPEPLOMCBGEORRXER8GIT9IOO9 NCAAL9L4A5B30O-R98A9T9ORY

NUNONIEFICPTMINOEEADSSTISLHTSAAEETGDRATYEES

FROM:

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Human SE

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BUSINESS REPLY MAIL FIRST-CLASS MAIL ELPTCOPEBMROGRXIRT8EO9G9CIPOAOSN9TAA4G5LE3LW0IA-LL9BPB8EOER9MPR9AITAIDNTOBO.Y3R0A2DYDRESSEEEL CERRITO CA

UNITEINFDINNEMSTOCTHAEAPIELSTOEESSDSATRAYGE

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Step 4. Patient Information

For Patients: If your label is missing at right, fill in your name and medical record number with a ballpoint pen.

If your label has incorrect information, call 1-866454-8855 to request a new kit.

For Staff use: Place Patient Visit Label (PVL) here and write PCP Name/Lab ID below:

[

Patient Name: Medical Record Number:

]

PCP Name/Lab ID:

? 2013, TPMG, Inc. All rights reserved. Health Engagement Consulting Services. 011061-376 (Revised 06/23) RL 5.6 FIT Kit Instructions Inreach

X RILIS mnemonic: FIT [fecal Hemoglobin] Inreach

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