QC Worksheet for Whole Blood Glucose Testing



Capillary Whole Blood Glucose Control Log Sheet

Manufacturer: ________________________________ SN: _______________

Health Dept: __________________________________ Site: ________________

QC Data (reagent specifics)

| |Lot Number |Expiration Date |Expected Range |

|Optics check or | | | | |

|Calibration strip | | | | |

|High Level Control | | | | |

|Low Level Control | | | | |

|Test Strip | | |type: [ ] GOD [ ] GDH |

Q.C. Results for each run

|Optics check or |High Control |Low Control |Pass/ |Date |Initials |

|Calibration strip | | |Fail | | |

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Date Corrective Action: (use reverse side as needed)

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_________________________ ___/___/___ _____________________________ ____/____/____

Site Coordinator: Date Laboratory Director/Technical Consultant Date

RLF-53

Rev. 6/9/2006

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