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COAGULATION
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 method and instrument used for the
determination of each parameter. If you would like multi-instrument evaluation please fill up a
questionnaire for each of the instruments.
Instructions:
 Method: thick the box in front of the method used for the determination of the specified
parameter. In case you can't find you method in the list thick the box Other method and
write the exact name of your method.
 Instrument: Write the name of your main instrument in the field Main Instrument. În case if
you determine a parameter using a different instrument as the main one thick the box in
front of Other and write the exact name of your instrument.
 Reagent producer: write the name of of the reagent producer
 Unit of measurement: in case you are using an other unit of measurement than the specified
one please write it in the field Other
Main Instrument:
Timp protrombină, s
Method:
Instrument:
Main
Other:
Reagent producer:
APTT, s
Method:
Instrument:
Main
Other:
Reagent producer:
Unit of measurement:
INR, s
Method:
Instrument:
Main
Other:
Reagent producer:
Fibrinogen, mg/dl
Method:
Instrument:
Main
Other:
Reagent producer:
Main
Other:
Unit of measurement:
PT , %
Method:
Instrument:
Main
Other:
Main
Other:
Reagent producer:
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