Escolar Documentos
Profissional Documentos
Cultura Documentos
Department of Health
SAN LAZARO HOSPITAL
National Reference Laboratory for HIV / AIDS, Hepatitis B & C, and Syphilis
STD / AIDS Cooperative Central Laboratory
Quiricada St., Sta. Cruz, Manila
Tel Nos: (632)3109528/29 TeleFax: (632)7114117
website: saccl.doh.gov.ph Email: nrlslhsaccl@yahoo.com.ph
( ) not available
Reporting of Results:
Were you able to encode your results to OASYS? ( )Yes ( )No; If No, give reason for failure to submit result
through the system:
________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
NOTE: INCOMPLETE FILLED UP FORMS ARE NOT ACCEPTABLE
ALL participants, are required to encode their results to OASYS. Failure to encode
means no result submitted and does not warrant the issuance of Certificate of
Participation for the current Test Event.
Page 1 of 3 for HBsAg report form
HBsAg Testing
LABORATORY REPORT FORM
Laboratory Code: __________
)R
)R
)R
)R
)R
(
(
(
(
(
RESULT
)NR
)NR
)NR
)NR
)NR
(
(
(
(
(
)Inc
)Inc
)Inc
)Inc
)Inc
Note: For Rapid tests, encode one run result only in OASYS
CutOff
(B)
S/CO
(AB)
OD(A)
Dup 1
Dup 2
Assay Interpretation
S/CO (AB)
Dup 1
Dup 2
( )R
( )NR
( )Inc
( )R
( )NR
( )Inc
( )R
( )NR
( )Inc
( )R
( )NR
( )Inc
( )R
( )NR
( )Inc
1st run
( ) S/CO ( )S/N ( )mIU/ml
( ) Others (Pls specify) _________
Assay Interpretation
Dup 2
( )R
( )NR
( )Inc
( )R
( )NR
( )Inc
( )R
( )NR
( )Inc
( )R
( )NR
( )Inc
( )R
( )NR
( )Inc
Frequency of use of internal QC ( using known (-) and (+) excluding ICT controls in HBsAg test device), every
( ) test run ( ) new operator
( ) new lot
( ) daily
( ) weekly
( ) monthly
( ) shift
( ) after certain number of tests ( ) others __________
Do you use other quality control samples (not included in HBsAg test kit) in your regular testing?
( )No ( ) if yes complete information below
Source: ( ) In-house, prepared by own laboratory
( ) Commercial, pls specify name: ________________________
Do you do HBsAg confirmatory test? ( )yes ( )no
If yes, Indicate brand/manufacturer of reagent used ________________________________________
If no, what do you do with initially reactive results?
( ) report initial test result
( ) refer , to whom?
( ) other referral laboratory
( ) NRL
( ) repeat testing
( ) using same kit, then report result
( ) using another kit, different principle, report
( ) other
Name of person completing these HBsAg test result forms: ____________________________________
Name/ Designation (Sign over printed name)
Date:_____________________
Supervisor: __________________________________
Name/ Designation (Sign over printed name)
Date: _________________