EQUIPMENT/INSTRUMENTS/GLASSWARE/SUPPLIES/REAGENTS PER AREA OF _ACTIVITY/SERVICE. CAPABILITY OF GENERAL CLINICAL LABORATORY (Place a ¥ on spaces provided before cach item if available and X ifnot; or NA for Not Applicable) Note: These are the list of minimum requirements as to equipment, reagents/culture media, supplies & Glassware’s. Additional services are acceptable provided that appropriate items mentioned with technical procedures, space and personnel are available, if necessary. (Please use additional sheet of paper, if needed.) ‘ACTIVITY | SERVICES| GLASSWARE AND SUPPLIES REMARKS — 70% Alcohol Zcations Touriquct Lancet traction | —_€aBillary Tubes Blood Extraction | ~Taheting Materials Test Tubes sterile Meal tape | syringe and Needle-any gauge SPECIMEN | Expiration Date) COLLECTION __Puneture Proof Sharps Container Applicator Stick Specimen container w/ cover or Screw Other Body Fluids | = (Urine, Stool, | *PGOML) Sputum, ec) _ Sterile Serew Cap Specimen Container, applicable Plastic calibrated loop and other iseessary materials, itappicable “— Not-Mereurial Thermometer for iemperature monitoring orneR “_ Refrigerator (samples) BQUIEMENT. __ Fre Extinguisher (Class B) __ spill Kits EQUIPMENT SERVICES INSTRUMENT! || qutetacetey) canraroen0 GLASSWARE/SUPPLIES Clinical Microscopy WETSMEAR for | Supplies ‘Trichomonas — Sides Normal Sai Cover Slips ghorm! Stlne — Scinion — | Applicator sticks Mi tte FECALYSIS| - Microscope (incl Compound) PREGNANCY TEST | __ Pregnancy tes kit FECAL OCCULT FacaL Occult blood tet it DOHHFSRE-CLG-AT ArnexB2 Roast 00 oeSERVICES EQUIPMENT / INSTRUMENT / GLASSWARE/SUPPLIES REAGENT/S (Fake Note of Expiry) REMARKS (Quality Improvement) URINALYSIS Supplies _ Slides Test tubes (10m) Cover Slips [Test Tube Rack = Applicator sticks _Manual “Clinical Centrifuge 2,000 rpm [Microscope (inocula Compound) Automated __ Strip Reader Urine Analyzer Urine Strips (Gelect which applies) '4- parameter —10- parameter Control/s ‘Noma Sato ‘Additional Services (Add-On Services) Tndieate the test use separate sheet as necessary Tndicate needed agulpmenistrument/Reagents! GlasewareSuppliee ‘Hematology HEMOGLOBIN _ Manual _ Specitophotometer or its equivalent __Cavettesitest tubes — Sabli/micropipette Hemoglobin Reagent (Cyanme Hemoglobin) _ Standard HEMATOCRIT Manual __ Hematocrit Centrifuge Hematocrit Reader =Capittary Tube Sealer RED BLOOD CELLS (Orsinal WHITE BLOOD CELLS PLATELET COUNT Quamiative) _Manwal —_ Microscope ‘Binocular Compound) Pipette Shaker = Tally Counter RBC! micropipette = Counting Chamber w/ Cover Slips __WBC/ micropipette Peri Dish as applicable) _RBC Diluent ‘Other reagent WBC Difuent __Platelet Diluent DIFFERENTIAL COUNT Manual ~_ Differential Counter — Slides — Staining Glasses = Microscope _ Binocular Compound) _ Hematology Staining Kit il immersion ‘DONHFSRE-CLE-AT Anne Revisor 00 72) PReaeeEQUIPMENT / SERVICES INSTRUMENT / (REAGENTS. REMARKS GLASSWARE/SUPPLIES Sees __Diluents __Lyse cleanse Solution COMPLETE BLOOD | __ Automated Other Reagents couNT Hematology Analyzer Controls a tow Nema aie “_Serofige or its equivalent Normal Saline rest Tubes Solution FORWARD AND GROUPING AND Rh | —"200*! — Blood Typing Sera (D)TYPING crate | __Semi-automated machine —Keonm Cal Meied) A ved. __ Gel-type based blood _Automai as | ‘Hospital-Based Secondary CL 5 __ Coagulation Machine Coagulation COAGULATION | — catirated Pipettes Reagents ° __Cuvettes or its equivalent — Controls Additional Services (Add-On Services) Tdieate the tst—sse | ladies nvded separate shee asnecenary Clinical Chemistry _Reftigerator cages) cainieal Centrifuge Disilled Water Water Bath orits equivalent | — Standard/ Calibrator ROUTINE: Calibrated Pipettes Controls Blood Glucose _ Pig Normal — Pipette tips Pathologie (08 1B) ins = ‘Total Cholesterol | — RET Pipetes 1 rides — Timer not Touvetes Test Reagents Blood Urie Acid Tes Tubes Score Blood Creatinine | — Test Tubes Rack = Ral Geter | Blood Urea HDL Nitrogen _ Manual ne Acid | Spectrophotometer or is Serene Sauivalent See Oral Glucose — Automated Tolerance Drink ~Chemistry Analyzer OORHFERE-GLE-AT An ‘ono Paaedo6EQUIPMENT / SERVICES INSTRUMENT dattseete) gut prem) GLASSWARE/SUPPLIES [Hospital-Based Secondary CL __ Manual T Spectrophotometer or its __ Test Reagents ELECTOLYTES — | Zuvatent, No (Sa, Cl, x _ Automated Analyzer 7 ‘ete mci ‘Additional Services (Add-On Services) Tndiate the test—ase | Tadlente oreo parse sect avneceary | Equpmentnstramen Reagents CGlaseraretuppter Immunology / Serology Tndieate the rapid Eaveties lateral flow serologie | — Test Tubes or immunological” | Test Tubes Rack ingnostic test (Le, | Glass Pipettes __ Standard/ Calibrator, Rapid Test Kits for~ | — Pipettes & Pipette tips iFapplicable Dengue, Syphilis, Hepatitis B (screening), | __ Rapid test kits as applicable | Controls, if applicable HIV sereening))—vse | __Dengue Manes seputeshetasecesary | Syphilis = Hepatitis B (reine) Test Reagents, if HIV Goring) applicable __ Microscope oF apslutnation — Distilled Water T Standard Calibrator Controls Indicated the ‘machine-based serological or immunological test __ Automated Analyzer ‘ticate the mame of machine) __ Manual _ Spectrophotometer or its equivalent ‘Test Reagents, as applicable PP Tamer Markers ‘Thyroid Function Heats Poe otters applicable “Additional Services (Add-On Services) Tndieate the test ~ use separate sheet as necessary Tadleate needed ipmenvTastrumenReagents Glassvare’Supplies DOMHFERS-CLG-AT AmexB2 Revisor: 00EQUIPMENT / SERVICES INSTRUMENT / REAGENTS. ES GLASSWARE/SUPPLIES = Microbiology Staining Rack Timer Kou T stides __10% KOH inoculating Loops = applicator Sticks Forceps GRAM STAIN centage, a appt Grams stain kit Biosafety cabinet (ise Type it cerendn), a aptene Caiture Media: {Sale wich appt) “BHT BAP Tac — car cabinet , | SBA —BCA abicatey atnercmentnes | Se iS Incubator Sia Tsp prying Oven SFB. _APW Autoclave —TcBs Weighing Scale —Thio broth War Bah MBA Ww 5% sheep rable Lamp Blood = Blectric/Gas Stove — Others, indicate: Refrigerator with freezer _Sterile Swabs CULTURE AND Candle Jar SENSITIVITY —Caliper/Ruter (eerbianserbic) ~ Graduated Cylinder _ Biochemical aoe Reaction (Conventional Erlenmeyer flask Cy Prout — Petri dish ~ Glass Pipetes Sensitivity Calibrated Inoeuating Loops | Disks Antimicrobial Laboratory Thermometer Dik pam rr a __ Mac Farland toma m (adieu sane omc) =, Control Strains (arco: Mr pend Spores erat Teeth co Additional Services (Add-On Services) India the test— se | ewe sed sepatesetavaeenry_| Equipe ntromen Rene DOnAFSRD.OLGAT pone Rosson 7 ne Paes ot6EQUIPMENT / rareSuppies SERVICES INSTRUMENT / REAGENTS. eek oF GLASSWARE/SUPPLIES Anato Microscope eter Compound) ran cervico- | _ Timer VAGINAL ~ Slides CYTOLOGY — Cover Slips ___ Papanicolaou stain (PAPSMEAR) ~ Adhesive or its equivalent — Forceps taining Glasses (Selct which appt) __ Paraffin Oven = Foun Microtome Paraffin wex = xylene — Fume Hood __ Carbon tetrachloride HISTOPATHOLOGY | _ Manual Technique ee Bensoiis & | Water Bath ean Whe 50%, 100%) __Automatic tissue processor | __ Others, indicate: | __ Isopentane FROZEN SECTION, | _ Cryostat alienating if applicable Block holder sn Stn st, 50%) —Raler T Autopsy Table Bone Saw AUTOPSY, if ~ Scalpel applicable Scissors Rib shears ~ Toothed Forceps ~ Weighing Seale Additional Services (Add-On Services) Tdieate the test use | lndieateneded | separateshetaseesesry | Eauipmenvnstrament Reagent! ‘DOH-HFSRS.CLG-AT Ames?EQUIPMENT / REAGENT/S REMARKS SERVICES INSTRUMENT! uF es | ounoretne Pees Limited Service Tndieate the test (Le., | Indicate newded DOH-Program based | Fatlementntrnent Reseed related tests such as ear, rapid plasma reagin for syphilis, DSSM/AFB smear for tuberculosis, HIV test) ~ se separate sheet a8 necessary DOHHFSRS.CLE-AT Amexs2 Pana? o6