NATIONAL EXTERNAL QUALITY ASSESSMENT SCHEME FOR SEROLOGY

2019 REGISTRATION FORM

Check the box
New Participant Old Participant / Renewal (Indicate SACCL Code:_______________________)
if:
LABORATORY INFORMATION
Name of Laboratory: Telephone/Fax Nos.

Address: Zip code: Region:

Designated EQAS Contact Person: Contact No.

Email address of EQAS Contact Person (mandatory):

Ownership Classification Service Capability

Government Primary w/ blood banking Free-standing TB Dots Clinic
service capabilities
Private Secondary Social Hygiene City Health Office
Clinic (SHC)
w/o blood banking
Tertiary RHU Others:_________
service capabilities
Certifications/Accreditations: ISO 15189:2013 ISO 9001:2015 Others:___________________

LABORATORY PERSONNEL
Name of Pathologist or Head of Facility Mobile No. & E-mail
(Signature over printed name) :
Name of Medical Technologist / Mobile No. & E-mail
Operator (Signature over printed
name) : (Indicate HIV Proficiency Number if possible)
TEST EVENT / ANALYTE
2018 - Census
Check the EQAS analyte/s (test event) Total # of Total # of
Method Total # of tests
your laboratory will be participating in. reactive positive
done
(screening) (confirmatory)
HIV Rapid Immunoassay

HBV Rapid Immunoassay

HCV Rapid Immunoassay

Syphilis Rapid Immunoassay

This laboratory agrees to abide by the

rules of participation of the NRL EQAS. CONFORME:
(Signature over printed name of person accomplishing this form)

PAYMENT DETAILS (For NRL SLH/SACCL USE ONLY)

Mode of Received by: Date/Time Received:
Cash Check Deposit slip
Payment:
OR Number: Remarks:

Amount:

NRL
SLH-SACCL
Department of Health / San Lazaro Hospital
National Reference Laboratory for HIV/AIDS,
Hepatitis B/C, and Syphilis
STD AIDS Cooperative Central Laboratory
Bldg 17, San Lazaro Hospital
Compound, Quiricada St., Sta
Cruz, Manila, Philippines, 1003
Mon - Fri, 8-4pm
Tel Nos: +63 2 7323776 / 3109528 /
3109529 / 3105786 / Fax: +63 2 7114117
www.nrlslhsaccl.com.ph
[email protected]
 NRL
SLH-SACCL STD AIDS Cooperative Central Laboratory Mon - Fri, 8-4pm [email protected]
(PARTICIPANTS COPY. DO NOT SUBMIT)

STEPS IN REGISTRATION

STEP 1 Completely fill out NRL-SLH/SACCL 2019 EQAS REGISTRATION FORM. Check the analyte
/test event your laboratory want to participate in and take note of the registration fees:
One (1) analyte = Php 2,500.00 Two (2) or more = Php 4,500.00

STEP 2 Pay directly to the San Lazaro Hospital cashier or through over-the-counter deposit
at any LANDBANK branch using the details below:

Account Name: SAN LAZARO HOSPITAL

Account Number: 1432-1044-15
LANDBANK branch: Tayuman, Manila

STEP 3 Submit the REGISTRATION FORM, PROOF OF PAYMENT (ie. Official Receipt or deposit
slip), and a copy of the laboratory's LICENSE TO OPERATE (LTO) to the NRL-SLH/SACCL
for processing.

STEP 4 An email notification will be sent prior shipment of EQAS panels. Wait for any
announcements at the official NRL-SLH/SACCL website and Facebook page.

VERY IMPORTANT NOTES:

*The EQAS person-in-charge of your laboratory must assign an email address to be used only for the Serology
EQAS OASYS account.
*Secure a duplicate copy of the registration form, offical receipts, and deposit slips.
*Incomplete requirements will not be accepted.
*ONLY participating laboratories with UNSATISFACTORY 2018 EQAS results will be notified to submit a
CORRECTIVE ACTION Form.
*Laboratories who will fail to encode their results online will not receive a certificate of participation.
*Any refunds (eg. overpayment) shall be processed by any representative of the participating laboratory at the
San Lazaro Hospital cashier.
*For further inquiries, kindly contact Ms. Felyrose Fuertes and Ms. Patricia Pomar at these numbers: 02-3109528
to 29 or email at [email protected].

NRL
Department of Health / San Lazaro Hospital Bldg 17, San Lazaro Hospital Tel Nos: +63 2 7323776 / 3109528 /
National Reference Laboratory for HIV/AIDS, Compound, Quiricada St., Sta 3109529 / 3105786 / Fax: +63 2 7114117
Hepatitis B/C, and Syphilis Cruz, Manila, Philippines, 1003 www.nrlslhsaccl.com.ph
SLH-SACCL STD AIDS Cooperative Central Laboratory Mon - Fri, 8-4pm [email protected]