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POCT Consumable Request Form

This document is a request form for point of care testing consumables for various diagnostic devices used at a hospital laboratory. It lists 11 items needed for a blood gas analyzer, 4 items for a glucometer, 3 items for an HbA1c analyzer, 3 rapid test kits, 3 items for urine tests, and 2 general consumables. The form requires the requester's name and signature along with the name and signature of the issuer approving the request.

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visitmewonde
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123 views1 page

POCT Consumable Request Form

This document is a request form for point of care testing consumables for various diagnostic devices used at a hospital laboratory. It lists 11 items needed for a blood gas analyzer, 4 items for a glucometer, 3 items for an HbA1c analyzer, 3 rapid test kits, 3 items for urine tests, and 2 general consumables. The form requires the requester's name and signature along with the name and signature of the issuer approving the request.

Uploaded by

visitmewonde
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

POINT OF CARE TESTING (POCT) CONSUMABLE

PL-POCT-FR-002
REQUEST FORM

REQUEST DATE HOSPITAL/LABORATORY


ISSUED DATE DEPARTMENT
QUANTITY QUANTITY
S. NO ITEM CODE ITEM REMARKS
DEMANDED ISSUED
BLOOD GAS ANALYZER – SIEMENS RAPIDPOINT 500
1 10491447 Measuring Cartridge 250 Tests
2 10491448 Measuring Cartridge 400 Tests
3 10491449 Measuring Cartridge 750 Tests
4 10310323 AQC Cartridge
5 10329097 WASH/WASTE Cartridge (4pc/Box)
6 TR57X70 Printer paper Roll size-57x70 mm (1x1)
7 10309073 Sample port (20 pc/Packet)
8 05.1147.028 Blood Gas sterile syringe Monovette 2ml, (1X100Pcs)
9 51.931.140 Blood Gas capillary set 140ul (1x200 Pcs)
10 10316535 RP 500, RL CVM
11 14.1148 Ventilation f. Blood gas Monovette (500 pc/box)
GLUCOMETER-CARE SENS EXPERT +
1 299104 Caresens expert glucose strips (50 Strips/Box)
2 299570 CS Expert Control L&H/Pack
3 299153 KetoSens Blood B-Ketone Test strips
4 299570-202 KetoSens Control Solution L&H
HBA1C ANALYZER – SIEMENS DCA VANTAGE
1 10698915 DCA HbA1c Reagent Kit (10 Kits/Box)
2 10311161 DCAHbA1c Controls (Normal and Abnormal) 2 Each/Box
3 TR57X45 Printer paper Roll size-57x45 mm (1x1)
RAPID TEST KIT
1 21HCG Urine Pregnancy Kit (40 tests/box)
2 20183 QuickVue Influenza A+B Test (25 tests/box)
3 20108 QuickVue Strep A (50 tests/box)
URINE DIPSTICK AND SIEMENS CLINITEK STATUS
1 10319133 Multistix 10 SG Urine Strips (100pc/Box)
10325654 Chek-Stick, Combo Pack-Urine Controls (25
2
Strips/bottle)
3 TR57X45 Printer paper Roll size-57x45 mm (1 x 1)
GENERAL CONSUMABLES
1 85.1019 Sarstedt Safety-Lancet Neonatal (1 x 200 pc)
2 85.1016 Sarstedt Safety-Lancet Normal (1 x 200 pc)
REQUESTED BY (Name and
DATE AND SIGNATURE
Employee ID)
ISSUED BY (Name and
DATE AND SIGNATURE
Employee ID)

Revision No: 3 Page No: 1 / 1 Revision Date: 22/06/2022

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