PLEASE SEND A COPY OF YOUR KIT INSERT ENROLMENT DOCUMENT

Document Sample
PLEASE SEND A COPY OF YOUR KIT INSERT ENROLMENT DOCUMENT Powered By Docstoc
					                  RIQAS
RANDOX INTERNATIONAL QUALITY ASSESSMENT SCHEME




            ENROLMENT DOCUMENT
            URINALYSIS PROGRAMME




   PLEASE SEND A COPY OF YOUR KIT INSERT
     THIS SHOULD CLEARLY STATE THE CATEGORIES OF
   REPORTED RESULTS EXPECTED FOR EACH PARAMETER




       This document must be completed and returned to RIQAS
                                                                 Lab. Reference Number


                                                   RIQAS
                                      URINALYSIS PROGRAMME
                                             RQ9138
Official Order No.                                                                    Date
Official Order No. required for UK & Ireland only - Please ensure official purchase order number accompanies enrolment documents
Please indicate cycles required in boxes below
Cycle 1       January 2009 - December 2009                          Cycle 2        January 2010 - December 2010


Routine report to be sent to: (CAPITAL LETTERS ONLY)
QA Officer


Laboratory / Hospital Name


Department


Postal Address




Postal / Zip Code                                 Country


Telephone Number                                                         Fax Number


E-mail Address


Distributor


Please copy and complete separate registration details for multiple instruments
Instrument and inter-laboratory group reports can be provided on request. Please contact RIQAS or your local Randox office or
distributor for more details.
Additional certificate details and copies (this service will incur an administration fee)
Complimentary certificates of participation for each RIQAS programme are available to participants at the end of the current cycle,
provided that at least 50% of results have been returned. The certificate will specify the cycle, programme and the LABORATORY /
HOSPITAL NAME specified in the address details above. However, there will be an administration charge for modifications or
additions to the standard certificate. A maximum of three lines will be permitted for a modified certificate. Please state modifications
below. There will also be an administration charge for additional copies of certificates. Modified certificates may be requested through
your local Randox office or distributor.




Please contact RIQAS at
Tel:         +44 (0) 28 9445 4399
Fax:          +44 (0) 28 9445 4398
E-Mail:       mail@riqas.com
e-transfer: returns@riqas.com
RANDOX LABORATORIES LTD., Ardmore, Diamond Road, Crumlin, Co. Antrim, United Kingdom, BT29 4QY
Revised July 2008




                                                                   2/3
                                                    Lab. Reference Number

RIQAS URINALYSIS PROGRAMME
REGISTRATION OF METHODS
Please indicate your requirements by writing in the boxes below.
Current participants should complete the document only for method changes.

ANALYTE                     METHOD CODE            INSTRUMENT CODE       SUPPLIER CODE   UNIT/ARB CODE

ALBUMIN


BILIRUBIN


BLOOD


CREATININE


GALACTOSE


GLUCOSE


HCG


KETONES


LEUKOCYTES


NITRITE


PH


PROTEIN


SPECIFIC GRAVITY


UROBILINOGEN


Please use this space to describe "other" methods & instruments.




               PLEASE SEND A COPY OF YOUR KIT INSERT
                 THIS SHOULD CLEARLY STATE THE CATEGORIES OF
                REPORTED RESULTS EXPECTED FOR EACH PARAMETER
                                                      3/3