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F-QM-002-A-V0 — Document Change, Annual Review, and Disposal Request Form

Type: Form · Version: V0 · Status: DRAFT — UNAPPROVED · Served read-only from the bundled QMS copies. The Drive master is untouched.

Parent document: LAB-QM-002 — Document Control Policy (parent is encoded in the form number)

Rendered in-browser from the project's Word file F-QM-002-A-V0-document-change-and-review-request-form.docx (policies-docx / forms-docx — the file Junry reviews). Formatting is faithful, not pixel-perfect; the DOCX is the official copy.

Document #	F-QM-002-A-V0	Parent Document	LAB-QM-002 — Document Control Policy

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Part 1 — Document Change Request & Justification

Request Tracking No.:	DCR-YYYY-____	Date of Request:
Document Number:		Current Version No.:
Document Title:		Proposed Version No.:
Laboratory Section:	[ ] Hematology [ ] Clinical Microscopy [ ] Serology [ ] General QM [ ] Cross-Discipline
Originator / Author:	____________________________________, RMT

1.1 Action Requested (Check One)

[ ] New Document Creation: Establish new policy, SOP, or form for a newly introduced test or clinical workflow.
[ ] Document Revision / Amendment: Modify procedural steps, reference intervals, controls, or regulatory crosswalks.
[ ] Periodic / Annual Review (No Substantive Changes): Formal annual review confirming the document is still valid for use.
[ ] Document Retirement / Obsolescence: Decommission procedure or form due to phased-out equipment or method change.

1.2 Summary of Proposed Changes and Operational Impact

(Specify sections or clauses modified, reason for amendment, and manufacturer/DOH regulatory trigger): ____________________________________________________________________________________________________ ____________________________________________________________________________________________________

[ ] Staff training required prior to effective date (briefing documented on F-QM-HR-001-A).
[ ] Related SOPs and forms affected and updated at the same time.
[ ] Lab-LIS or reporting format impact verified.

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Part 2 — Annual Policy and Procedure Review Tracking Log

The Chief Medical Technologist / Laboratory Quality Manager maintains this log to track the annual review of all controlled documents:

Document No.	Document Title	Category / Section	Current Ver.	Review Due Date	Designated Reviewer
LAB-QM-001	Quality Management Manual	General QM	V0	Annual	CMT / LQM
LAB-QM-002	Document Control Policy	General QM	V0	Annual	CMT / LQM
SOP-H-002	HORIBA ABX Pentra XL 80 CBC and Maintenance SOP	Hematology	V0	Annual	Medical Technologist
SOP-H-001	Hematology Section Workflow, Quality Control, and Result Validation SOP	Hematology	V0	Annual	Medical Technologist
SOP-S-004	Dengue Duo and Typhoid Rapid Immunoassay SOP	Serology	V0	Annual	Medical Technologist

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Part 3 — Obsolete Master Document and Records Disposal Authorization Log

Document withdrawal and destruction authorization per LAB-QM-002 Section 5.5 and LAB-QM-POST-004:

Log No.	Hard Copies Retrieved & Destroyed	Electronic File Archived (Read-Only)	Disposal / Archive Method
D-2026-01	[ ] Yes [ ] N/A	[ ] Yes [ ] N/A	[ ] Shredding [ ] Secure Electronic Archive
D-2026-02	[ ] Yes [ ] N/A	[ ] Yes [ ] N/A	[ ] Shredding [ ] Secure Electronic Archive
D-2026-03	[ ] Yes [ ] N/A	[ ] Yes [ ] N/A	[ ] Shredding [ ] Secure Electronic Archive
D-2026-04	[ ] Yes [ ] N/A	[ ] Yes [ ] N/A	[ ] Shredding [ ] Secure Electronic Archive
D-2026-05	[ ] Yes [ ] N/A	[ ] Yes [ ] N/A	[ ] Shredding [ ] Secure Electronic Archive

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Part 4 — Technical Review, Approvals & Controlled Archive Sign-Off

Review Authority	Name & Designation	Signature	Date
Document Author / Initiator:
Chief Medical Technologist / LQM:	Junry, RMT
Pathologist / Head of Laboratory:
Hospital Director (for Manual/Policies):

Document Control Master Update Checklist:

[ ] New master file deposited in controlled repository.
[ ] Master Document Register (F-QM-002-B) updated.
[ ] Superseded version marked "OBSOLETE" and moved to archive folder.
[ ] Hard copies in laboratory testing areas replaced and old copies destroyed. Effective Release Date: YYYY-MM-DD | Verified by (CMT / LQM): _______________________