Reference Interval Verification.xlsx

	A	B	C	D	E	F	G	T	U	V	W	X	Y
1	Ministry/ Establishment/ Authority ………… Directorate/ company/ Sector ………….....… Hospital/ Facility ………………………………….…					وزارة / مؤسسة / هيئة ............................... مديرية / شركة / قطاع ............................... مستشفى / منشأة ......................................
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6	Reference Interval Verification / Re-Evaluation Form
7				Date:
8	Section:					Analyzer:
9	Analyte:					Method:
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11	Sample:	20 samples from healthy volunteers
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13	Procedure:	Run 20 samples from healthy volunteers
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15	(Note for Age, sex &/or other factor in indicated)				No. of Sample	Measured Value ↓	Comment
16	(Note for Age, sex &/or other factor in indicated)				1	.		0	0	1	1	1	←Out of Range
17	Unit:				2	.		0	0	1	1	1	←Out of Range
18	Designed By Dr. Mohammad Moharram				3	.		0	0	1	1	1	←Out of Range
19	Dedicated to ecpatlas.com				4	.		0	0	1	1	1	←Out of Range
20	Assigned Reference Value				5	.		0	0	1	1	1	←Out of Range
21	Assigned Reference Value				6	.		0	0	1	1	1	←Out of Range
22		to			7	.		0	0	1	1	1	←Out of Range
23		to			8	.		0	0	1	1	1	←Out of Range
24					9	.		0	0	1	1	1	←Out of Range
25	Observed 2SD Range	#DIV/0!	#DIV/0!		10	.		0	0	1	1	1	←Out of Range
26	Observed 2SD Range	#DIV/0!	#DIV/0!		11	.		0	0	1	1	1	←Out of Range
27	Acceptance Criteria: The test is considered verified if no more than 2 results are outside the manufacturer's or published range. (CLSI Guidelines EP28A3C)				12	.		0	0	1	1	1	←Out of Range
28					13	.		0	0	1	1	1	←Out of Range
29					14	.		0	0	1	1	1	←Out of Range
30					15	.		0	0	1	1	1	←Out of Range
31					16	.		0	0	1	1	1	←Out of Range
32					17	.		0	0	1	1	1	←Out of Range
33	WARNING: Use only yellow fields. Other fields may contain hidden formulas. If you edit or overwrite a white field , you may corrupt the formula(s)				18	.		0	0	1	1	1	←Out of Range
34					19	.		0	0	1	1	1	←Out of Range
35					20	.		0	0	1	1	1	←Out of Range
36								Sum	0	Sum	20
37	Conclusion: Reference range verification / Validation is considered						REJECTED
38							REJECTED		Sum of SUM		20
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40	Result Comment:				Corrective action (if needed):
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47			Section Supervisor		Section Head		Lab. Medical Director
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49	Policy No. …….... Form No. …....….
50	Completed forms are kept for 3 years or as per policy
51	Completed forms are kept for 3 years or as per policy
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