Data Submission Form Vit A

NCEH DLS Laboratory Quality Assurance Programs

Att 3f-II. VITAL-EQA DataReturn_VitA.xlsx

VITAL-EQA Data Submission Form (Clinical Lab)

OMB: 0920-1389

Document [xlsx]
Download: xlsx | pdf



















































Vitamin A Laboratory - External Quality Assurance Program (VITAL-EQA)


















Round 35 / Fat Solubles / Retinol

































































INSTRUCTIONS





























• E-mail this completed worksheet to: [email protected]

























• Round deadline:


December 18, 2020





















• All cells highlighted red are required or have invalid data that needs to be revised. Click on cell to see data requirements.

























• Run these samples in the same way as you would routine patient samples.

























• Run in singlicate over a period of two consecutive days (Day 1 and Day 2).

























• Record all results with three significant figures (i.e., 105, 10.5, 1.05, 0.105).

























• Retain the vials in your ultra-cold freezer for at least two weeks after data submission in case there is a question about the ID code or results.














































































Laboratory ID


















































Received Date (MM/DD/YY)









































Assay Type


































Instrument



(Manufacturer/Model)












Kit Information (if used)



(Name/Manufacturer)











































Low
High















Calibration Range



µg/dL
µg/dL









































LOD



µg/dL













































Run Assay Date Sample ID
Result
(µg/dL)
< LOD Note

1

1





1





1




2

1





1




1































Laboratory Notes











































OFFICIAL USE ONLY






































































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