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Laboratory Downtime Manual Result Form

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Does anyone have Downtime Manual Result Forms they would be willing to send?  We only have ours in paper format and desperately need a workable document.


Thanks, Jeremy

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LAB POINT OF CARE UNREGISTERED PATIENT TESTING INFORMATION


 


Use the following protocol whenever it is necessary to complete a POC test before a patient CSN number is available.


 









 


 










 


 











Place patient sticker here if available- there is no need to fill in last name, first name, DOB below if a sticker is available.


 



Step 1: At the Patient ID screen, scan the barcode below:


 


 


 


Step 2: Complete ALL of the information requested here:





















Patient's Last Name:


 


 


 



Patient's First Name:


 



Patient's DOB:


 



Instrument Used (circle one)


Accu-chek       iSTAT     


 


 


 



Test Date


and Time:



Instrument


Serial Number:



Test


Performed:


 


 


 



Operator Name (print clearly):



Nursing Unit Location:


 


 



Step 3: I have reviewed the documentation and verified this is the correct patient and test information.


Operator Signature________________________________­­­­­­­­­­­­_______    Date­­­­­­­­­­­______________


Step 4:  Once complete, send to Lab Point of Care Department via the Pneumatic Tube Station


(Forms submitted without ALL requested data, including operator signature, will be returned.)

the barcode didn't copy but you would need to create one for your facility.

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Jeremy Williford
about 10 years ago
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