Holy Angel University

School of Nursing and Allied Medical Sciences

Department of Nursing

NAME DATE
YR/SECTION RATING

TASK 1 2 3 4 5 SCORE
Launching Average Good Very Good Exemplary
1. SPECIMEN COLLECTION PERFORMED PERFORMED PERFORMED PERFORMED PERFORMED
 Identified self and patient 1-2/6 3/6 4/6 5/6 ALL TASK
 Performed proper cleansing with antiseptics.
 Punctured on the middle of the skin striations.
 Wiped the first blood that came out
 Placed 3 separate drops of blood on the slide
 Blood drop is circular
2. ANALYTICAL PHASE
 Placed optimum drop of respective ANTISERA per drop of blood
 Mixed blood with different applicator sticks properly
 Mixed blood antisera mixture properly
 No spill or cross contamination of blood and mixture
 Examined reading on proper lighting
3. READING OF RESULTS
 Read results in anti A antiSERA( with agglutination or no agglutination)
 Read results in anti B antiSERA (with agglutination or no agglutination)
 Read results in Anti D antisera ( with agglutination or no agglutination)
 Reporting of ABO type
 Reporting of RH type
TOTAL

Conforme: Assessed by:

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Name and signature of Student Anatomy and Physiology Instructor