Scribd Logo
Upload

Welcome to Scribd!

  • 505 views

    2020 NEQAS CC Registration Form and Order of Payment

    Uploaded by

    Novie Fenecios
    The document provides information for the 2020 National External Quality Assessment Scheme in Clinical Chemistry. It contains details about the City Health Office of Mati laboratory such as the name, address, contact information, and staff who will receive the NEQAS-CC samples. It also specifies the mode of payment, reference number, and amount paid for participation in the assessment scheme.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    2020 NEQAS CC Registration Form and Order of Payment

    Uploaded by

    Novie Fenecios
    505 views2 pages
    The document provides information for the 2020 National External Quality Assessment Scheme in Clinical Chemistry. It contains details about the City Health Office of Mati laboratory such as the name, address, contact information, and staff who will receive the NEQAS-CC samples. It also specifies the mode of payment, reference number, and amount paid for participation in the assessment scheme.

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The document provides information for the 2020 National External Quality Assessment Scheme in Clinical Chemistry. It contains details about the City Health Office of Mati laboratory such as the name, address, contact information, and staff who will receive the NEQAS-CC samples. It also specifies the mode of payment, reference number, and amount paid for participation in the assessment scheme.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    505 views2 pages

    2020 NEQAS CC Registration Form and Order of Payment

    Uploaded by

    Novie Fenecios
    The document provides information for the 2020 National External Quality Assessment Scheme in Clinical Chemistry. It contains details about the City Health Office of Mati laboratory such as the name, address, contact information, and staff who will receive the NEQAS-CC samples. It also specifies the mode of payment, reference number, and amount paid for participation in the assessment scheme.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    2020​ ​N​ATIONAL ​E​XTERNAL ​Q​UALITY ​A​SSESSMENT ​S​CHEME in ​C​LINICAL ​C​HEMISTRY

    GENERAL INFORMATION
    Name of Clinical Laboratory (based on your Latest License to Operate)
    CITY HEALTH OFFICE OF MATI

    Complete Address (No./ Unit/ Street/ Barangay/ City/ Province) Region


    MADANG,CEBTRAL,MATI CITY, DAVAO ORIENTAL XI
    Laboratory E-mail Address: Telephone No. with Area Code or Contact Nos. Mobile No.

    [email protected] 3884-429 09174595456

    Head of Laboratory (Pathologist): DR.EDMUNDO J. VISITACION, JR

    Contact Nos. 09173084545


    Check Appropriate Boxes: ​CLASSIFICATION BY OWNERSHIP

    Government Secondary Institution-Based

    NEQAS-CC Participation:
    Renewal/Old Participant Year last Participated: ​2019
    FOR Laboratory Staff only:​ (To receive the NRL Documents and NEQAS-CC Samples)
    Name of Laboratory Staff Designation Mobile Number

    1 ​JASPER JAY QUILING LIM ​MEDICAL TECHNOLOGIST III ​09174595456

    2 ​DOROTHY JOYCE HABANA MEDICAL TECHNOLOGIST II ​09563658740

    3 ​ELISA CAIÑA MEDICAL LABORATORY TECHNICIAN 09285486897

    :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
    FOR LCP-NRL staff only:

    Over the Counter O.R. No: ______________ NRL CONTROL NO.

    Cash O.R. Date: ____________ 2020​ - _______________


    Mode of
    Payment Check Amount: ​P 8,000.00 Date Received:

    ​Bank to Bank Transaction:


    Date of deposit: 5/29/2020 _________________________
    2020​ ​N​ATIONAL ​E​XTERNAL ​Q​UALITY ​A​SSESSMENT ​S​CHEME in ​C​LINICAL ​C​HEMISTRY
    LCP NRL FILE COPY 
    Name of Clinical Laboratory: ​CITY HEALTH OFFICE OF MATI
    ​ CRONYMS ​NOT​ ALLOWED​ - unless specified)
    (Refer on your latest License to Operate - A

    Mode of Payment:

    ​Cash ​Check ​Over the Counter ​Bank to Bank

    For Check payments only:


    Bank:
    Branch:
    Check No.:
    Date:
    ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
    FOR LCP NRL STAFF ONLY:

    O.R. No.:___________ Received by:


    Amount: ​P 8,000.00 ​ ________________
    Date: ______________ Date:____________

    2020​ ​N​ATIONAL ​E​XTERNAL ​Q​UALITY ​A​SSESSMENT ​S​CHEME in ​C​LINICAL ​C​HEMISTRY


    LCP - CASHIER DIVISION 
    Name of Clinical Laboratory: ​CITY HEALTH OFFICE OF MATI
    (Refer on your latest License to Operate - ​ACRONYMS ​NOT​ ALLOWED​ - unless specified)

    Mode of Payment:

    ​Cash ​Check ​Over the Counter ​Bank to Bank

    For Check payments only:


    Bank:
    Branch:
    Check No.:
    Date:

    You might also like