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.

cholaboratory@yahoo.com 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

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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: