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									                                                            ENROLMENT FORM

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ISHTM-AIIMS EQAP PROGRAMME Room- 156, Haematology Deptt., 1 floor Cancer Hosp., AIIMS
New Delhi – 110029

We prefer you to communicate to us by email only ; < drrenuqc@gmail.com> however , incase of any acute
urgency, you may call Mr. S. C. Katoch on mobile no. – 9968113832 between 3 :00 & 4:00 PM from Monday to
Friday and 11:00AM to 12:00 Noon on Saturdays

1. Name of Contact Person _______________________________________________

2. Mobile No. of Contact Person_____________________________________________________

3. Name & full Address of the Laboratory/Hosp.___________________________________

                                                    ____________________________________________

                                                  _____________________________________________

                                              ______________________________________________

4.    E- mail ID     _________________________________________________________________

5. Number of patients investigated daily for blood Counts_________________________________

6. No. of Lab. Personnel for CBC____________________________________________________

7. Particulars of Basic internal Quality Control for precision----

     CUSUM/control chart/Gaussian curve/C.V./S.D. of duplicate test on patient’s specimens

8.      Source of standard___________________________________________________________

9     Particulars of Autoanalyser (only one autoanalyser)___________________________________

10       Category of Lab.______________ Private /Govt. owned/ISHTM member’s

        personal labs.

 11 Date of submission of Form______________________________________




                                                                        (Signature and seal of the participants)
          Note: To get fee concession, the ISHTM members operating their personal labs. should submit documentary proof of their ISHTM
          membership and fill up the provided declaration form. The Govt. owned institutions should also fill up the provided declaration
          form to avail fee concession. Any ISHTM members serving in any organization or sharing the laboratory with any other person will
          ot be eligible for fee concession.                                                                  P.T.O. for declaration forms
                                                                  Declaration Forms


                     To be filled by ISHTM members operating their personal labs


I hereby declare that

..............................................................................................................................

(Name of the lab) is my personal lab and is not shared by any other person except me.
It is also not connected with any other organization/hospital. I have submitted
documentary proof of my ISHTM membership.




       (Sign. of doctor with seal)




                                       To be filled by Govt. Institutions



I hereby declare that
........................................................................................................................

(name of institution ) is governed by ministry of...............................................................

Govt. of ..................................................................................




                                                                                 (Sign of head of institution with seal)
                                           INFORMATION SHEET

ISHTM – AIIMS EXTERNAL QUALITY ASSURANCE PROGRAMME Room – 156, Hematology Deptt.,
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         1 floor, Cancer Hosp., AIIMS, New Delhi-110029Email drrenuqc@gmail.com

We prefer you to communicate to us by email only; however , incase of any acute urgency, you may call
Mr. S. C. Katoch on mobile no. – 9968113832 between 3:00 & 4:00 PM from Monday to Friday and
11:00 AM to 12:00 Noon on Saturdays

    1. There is an ongoing EQAP Programme offered by Department of Hematology, AIIMS New Delhi
       which is opened to all the private and Govt. Labs who are concerned with credibility and accuracy
       of their hemogram results along with PS assessment. The principal objective of this programme is
       to provide an independent external assessment of quality of these tests. The programme is being
       conducted as per norms established by NABL on the basis of ISO IEC Guide 43-1 & 43-2. Our
       deptt. has been appointed as nodal centre for conducting EQAP by National accreditation board
       for Testing & Calibration Laboratories (NABL)The programme is officially endorsed by the Indian
       Society of Hematology & Transfusion Medicine (ISHTM)
    2. Tests Assessed: The participating labs will be sent specimens of stabilized whole blood for
       performing C.B.C. & red cell indices, a peripheral blood smear & a stained slide for retic count.
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    3. Schedule for sending specimens. The code no.1-400 should receive their specimens by 10
                th        th         th                              th       th       th            th
        Jan,10 April, 10 July & 10 Oct.; code no. 401-800 by 10 Feb, 10 May, 10 Aug., & 10 Nov
                                      th           th        th          th
       and code no. 801-1200 by 10 March, 10 June, 10 Sept, & 10 Dec. In case you don’t receive
       the specimens by these dates , inform us immediately so another set of specimens could be sent
    4. Token Fees: Being a govt sponsored programme, we are charging only token fees from the
       participating labs. The amount of fees, we charge from each participating lab is around half of the
       actual cost, so no any claim for refund of fees for missing any set/sets of specimens due to
       transporting problem will be entertained from any participant.
    5. How to become a Participant: The applicant labs should fill up the enclosed form at any time
       and send to ‘Professor incharge, External Quality assurance programme, Hematology Deptt,
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       Room No. 156, , 1 Floor, IRCH Bldg., AIIMS, New Delhi –110029’ along with the draft. Before
       enrolling for EQAP, the participants should ensure that they must have service centre of
       Blazeflash courier in their area as the specimens are sent by the said courier only.     The annual
       token fees for the term Jan. to December will be charged at the following rates in the form of a
       draft drawn in favour of ‘I.S.H.T.M.’ payable at New Delhi. No multicity cheque or any other type
       of cheque acceptable. No monthly basis adjustment of token fees is permissible. Applicant
       enrolling from Jan. to June will have to pay under mentioned full amount applicable up to ensuing
       month of Dec. and the ones who enrol from July onwards will be required to pay half of the under
       mentioned amount effective up to the month of December of that year. The rate of annual
       nominal participation fees effective from Jan. to Dec. for enrolment in EQAP, per autoanalyser, is
       as follows:

            1. All private labs………………………………. Rs.1500/-
            2. Govt. owned labs/ ISHTM members operating their
               personal Labs only…………………………………….… Rs. 1000/-

    6   Send your draft by regd. /speed post only not by courier.

   Note: To get fee concession, the ISHTM members operating their personal labs. should submit documentary proof
of their ISHTM membership and fill up the provided declaration form. The Govt. owned institutions should also fill up
the provided declaration form to avail fee concession. Any ISHTM members serving in any organization or sharing
the laboratory with any other person will not be eligible for fee concession.

								
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