)2( ‫مــــجمع عيــــادات زهــــرة األمـــــل الطبي‬

Zahrat ALAmal Medical Polyclinics (2)

ADDITION OF A NEW TEST

(Expanding Test Menu)
DATE: / /

TEST NAME:
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TEST PROVIDER:
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UNIT:
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METHOD VALIDATION:□ PASS □ FAIL

SOP/ RELATED FORMS:

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PROFICIENCY TESTING PROGRAM:□ PT □ APA

SAMPLE TYPE:
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REFERENCE RANGE:
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TURNAROUND TIME (TAT):

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STORAGE CONDITION:
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RESULT REPORT FORMAT:

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SERVICE CODE IN LIS:

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 )2( ‫مــــجمع عيــــادات زهــــرة األمـــــل الطبي‬

Zahrat ALAmal Medical Polyclinics (2)

INTERFACE TO LIS: □ YES □ NA

VALIDATION OF INTERFACE: □ PASS □ FAIL

TEST PRICE:□WALK-IN: ……………….. □REFERRING CLIENTS: ………………

REQUESTED BY:

CHECKED AND REVIEWED BY:

ADDED ON THE COMPUTER SYSTEM BY: