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  • TB DOTS Specimen - Releasing - Form

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    Kim Pero
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    This document is a TB Laboratory Result Releasing Form used by various tuberculosis laboratories and collection units to track patient test requests, receipt of samples, and release of results. It includes fields to record the patient name, test requested, date and time the sample was received by the lab, and date and time results were released. The form is signed by the endorsing official from the lab and by the receiving official from the collection unit to acknowledge transfer of results.

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    TB DOTS specimen_releasing_form

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    This document is a TB Laboratory Result Releasing Form used by various tuberculosis laboratories and collection units to track patient test requests, receipt of samples, and release of results. It includes fields to record the patient name, test requested, date and time the sample was received by the lab, and date and time results were released. The form is signed by the endorsing official from the lab and by the receiving official from the collection unit to acknowledge transfer of results.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    13 views1 page

    TB DOTS Specimen - Releasing - Form

    Uploaded by

    Kim Pero
    This document is a TB Laboratory Result Releasing Form used by various tuberculosis laboratories and collection units to track patient test requests, receipt of samples, and release of results. It includes fields to record the patient name, test requested, date and time the sample was received by the lab, and date and time results were released. The form is signed by the endorsing official from the lab and by the receiving official from the collection unit to acknowledge transfer of results.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    Department of Health

    National Tuberculosis Control Program

    TB Laboratory Result Releasing Form


    From: TML To: Collection Unit
    RTDL TML
    TBC Laboratory RTDL
    TB DST Laboratory TBC Laboratory
    LPA Laboratory TB DST Laboratory
    ____________________ LPA Laboratory

    Test Requested Date and Time Date and Time


    Laboratory Name (Xpert MTB/RIF/ Smear
    No. (SURNAME, Given Names, Name Received Released Remarks
    Serial No. Extension, Middle Name)
    Microscopy/ TB LAMP/
    MM/DD/YYYY MM/DD/YYYY
    LPA/ TBC/ DST)

    4
    5

    10

    11

    12

    13

    14
    15

    16

    17

    18

    19

    20

    Endorsed by: Date:


    Signature over Printed Name

    Received by: Date:


    Signature over Printed Name

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