URINE - STRIP AND SEDIMENTATION
First registration:
Registred client:
Participant ID1
Laboratory name:
Address:
City:
State:
Country:
Telephone number:
Fax number:
Mailing address2:
City:
County:
Contact person:
Primary e-mail address:
Alternative e-mail address:
Period of contract:
Samples/assay:
1 sample
2 sample
Number of instruments tested:
I hereby confirm that all the submited datas are correct.
Signature
1
2
Date:
In case of new registration the Participant Idea will be completed by the organizers.
Complete mailing address only if differes from the main address
Participant:
Fill up the questionnaire with data regarding the instrument used for the determination of the
parameters. If you would like multi-instrument evaluation please fill up a questionnaire for each of
the instruments.
Instrucţiuni:
 Instrument: Write the name of the instrument you use for the analysis
 Reagent producer: Write the name of of the reagent producer
Instrument:
Producător reactivi:
For further information please contact Nobis Labordiagnostica:
Tel: +40-264-403.516, +40-726-155270
Fax:+40-264-449.711
E-mail: [email protected]
Contact person: Peter Stelescu – Product Manager QS
Nobis Labordiagnostica S.R.L
18 Fântânele street, Cluj-Napoca, Cluj County, Romania