F-QM-ANA-004-A-V0 — EQAS / NEQAS Enrollment, Result Evaluation, Discordance Investigation & Alternative Assessment Log

Keep one master packet for each external proficiency testing survey cycle (NEQAS-SLH, NEQAS-NKTI, or DOH-accredited EQAS provider) and for semi-annual alternative assessment rounds.

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Part 1 — Survey Receipt, Package Inspection & Administrative Data

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Part 2 — Staff Testing Assignment & Routine Rotation Record

Policy Mandate: Treat PT samples as part of the routine workload. Rotate them among all Medical Technologists who perform patient testing. Do not use special replicate runs or contact other laboratories about them.

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Part 3 — Analytical Worksheet & Raw Results Recording

Record instrument name, reagent lot, calibration status, daily IQC, and raw instrument readout.

Online Portal Submission Verification: Date Submitted to Provider Portal: YYYY-MM-DD | Submitted by: _______________________, RMT Confirmation / Submission Receipt Filed: [ ] Yes [ ] Electronic screenshot / printout attached to packet

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Part 4 — Provider Performance Evaluation, Review & Scoring

Completed upon receipt of the official summary evaluation report from the PT provider.

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Part 5 — Investigation of Discordant PT Finding & Root-Cause Analysis

Required for any analyte score < 80% or absolute Z-score > 2.0. Complete the investigation within thirty (30) calendar days after the evaluation report is received.

5.1 Investigation Tracking & Event Identification

5.2 Systematic Error Source Checklist

5.3 Retest Analysis & Patient Impact Evaluation

• Retest of retained PT sample performed: Date: YYYY-MM-DD | Retest Result: ________________
• Finding: [ ] Retest confirms original reported value (methodological/calibration issue) [ ] Retest matches peer target (transcription/pre-analytical sample error)
• Patient Result Impact: Were clinical patient samples tested in the affected run? [ ] No [ ] Yes
• If Yes, were amended reports required? [ ] No [ ] Yes (Amended reports issued per Laboratory Reporting Policy)
• Corrective & Preventive Action (CAPA) Logged: [ ] CAPA Plan Initiated (Form F-QM-011-A-V0, Ref No.: ________________)

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Part 6 — Alternative Proficiency Assessment Register & Protocol

Maintained for tests performed at TCH where formal commercial EQAP/PT is unavailable or impractical (e.g., peripheral smear morphology, urine sediment microscopy, rapid serology test kits).

6.1 Master Register of Analytes Under Alternative Assessment

6.2 Semi-Annual Split-Sample Assessment Record

• Event Tracking No.: AAR-YYYY-____ | Round: [ ] Round 1 (Jan–Jun) [ ] Round 2 (Jul–Dec) | Date: YYYY-MM-DD
• Analyte Evaluated: ________________________ | Testing Medical Technologist: ________________________, RMT

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Part 7 — Review and Pathologist Sign-Off

7.1 Medical Technologists

We confirm that external quality assessment samples and alternative assessments were handled in the same way as routine patient specimens.

7.2 Chief Medical Technologist / Laboratory Quality Manager

• Summary Evaluation: [ ] Satisfactory overall performance [ ] Corrective action closed and verified
• Signature: ________________________________________ Date: ____________________

7.3 Pathologist / Head of Laboratory

• Final Clinical Authorization: [ ] Approved [ ] Additional reassessment required
• Signature: ________________________________________ Date: ____________________