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UVA HEALTH SYSTEM Medical Laboratories PROFICIENCY TEST RESULT EXCEPTION FORM Location: Response Date
 

Summary: UVA HEALTH SYSTEM Medical Laboratories PROFICIENCY TEST RESULT EXCEPTION FORM
Location: Response Date:
Proficiency test program: Medical Director for Testing:
Test performed:
Unacceptable Result Reported:
Acceptable result:
Analysis of unacceptable result: Yes No Yes No
Clerical Error Quality Control review of data from the day of challenge
On the part of the person performing the test QC performed and documented properly
On the part of the reviewer QC within established limits
On the part of the PT provider QC review of preceding month shows trend suggesting a problem
Instrument Maintenance Operator
Instrument had maintenance performed in the
month prior to the challenge
Instructions for preparation of material followed properly
Instrument has had maintenance performed
between the challenge and today
Operator had shown documented competency within the preceding month (by QC or
split patient comparisons
Investigative Actions Taken: To include a detailed outline of investigations in addition to above. Any shaded answer above must be specifically addressed.

  

Source: Acton, Scott - Department of Electrical and Computer Engineering, University of Virginia

 

Collections: Computer Technologies and Information Sciences