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TB Laboratory Specimen Receiving Form

The document is a TB Laboratory Specimen Receiving Form for the National TB Control Program, detailing the collection of specimens for drug-resistant tuberculosis testing. It includes patient information such as names, lab serial numbers, test types, collection dates, and follow-up details. The form is endorsed by Marivic L. Mantiles and indicates a date of receipt for the specimens.

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37 views6 pages

TB Laboratory Specimen Receiving Form

The document is a TB Laboratory Specimen Receiving Form for the National TB Control Program, detailing the collection of specimens for drug-resistant tuberculosis testing. It includes patient information such as names, lab serial numbers, test types, collection dates, and follow-up details. The form is endorsed by Marivic L. Mantiles and indicates a date of receipt for the specimens.

Uploaded by

valangelodeleonbugay
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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National TB Control Program (NTP)

Programmatic Management for Drug-resistant Tuberculosis

TB Laboratory Specimen Receiving Form

From: Dinalupihan
II- STC
RHU
Collection Unit To: DSSM Center
DSSM Center GeneXpert Center
GeneXpert Center CHD II Culture Center
Culture Center DST Center
DST Center LPA Center

Name REMARKS
No. Lab Serial No. (SURNAME, First Name)
Test (GX/DSSM/TBC/DST) Date(mm/dd/yy)
Collected (Month Follow up, Age, Sex,
Registration Group)

1 CERVANTES, Samuel Bea DSSM, TBC 6/11/2023 6th/ 38/ M/ Relapse

2 RAMOS Sr, Eduardo DSSM, TBC 6/11/2023 19th/ 50/ M/ Relapse

3 SALAC, Rodeo DSSM, TBC 6/11/2023 2nd post tx ff-up/ 41/ M/


Relapse
4 DELA CRUZ, Melchor DSSM, TBC 6/11/2023 4th/ 51/ M/ Relapse

5 TENORIO, Cezar DSSM, TBC 6/11/2023 14th/ 38/ M/ Relapse

6 GUEVARRA, Argie Boy DSSM, TBC 6/11/2023 1st/ 45/ M/ New

7 PULANGCO, Romar DSSM, TBC 6/11/2023 9th / 37/ M/ New

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Endorsed by: Marivic L. Mantiles Date: 7/11/2023


Signature over printed name
Received by: Date:
Signature over printed name
BBBBBBBBB

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