F-QM-PRE-003-A-V0 — Specimen Receipt, Transport, Rejection & Recollection Log
Type: Form · Version: V0 · Status: DRAFT — UNAPPROVED · Served read-only from the bundled QMS copies. The Drive master is untouched.
Parent document: LAB-QM-PRE-003 — Specimen Handling, Packaging and Transportation Policy (parent is encoded in the form number)
Rendered in-browser from the project's Word file F-QM-PRE-003-A-V0-comprehensive-specimen-accessioning-and-rejection-log.docx (policies-docx / forms-docx — the file Junry reviews). Formatting is faithful, not pixel-perfect; the DOCX is the official copy.
| Document # | F-QM-PRE-003-A-V0 | Parent Document | LAB-QM-PRE-003 — Specimen Handling, Packaging and Transportation Policy |
|---|
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# SECTION A — ACCESSIONING PROTOCOL & CRITERIA REFERENCE
Standard Verification Rule: The two patient identifiers (Full Patient Name and Hospital Record/MRN No.) on the primary container label must match the laboratory test request form.
Standard Specimen Rejection Codes:
- R1: Unlabeled container or missing two mandatory patient identifiers.
- R2: Mislabeled specimen (container label does not match requisition form).
- R3: Quantity not sufficient (QNS / inadequate volume for complete testing).
- R4: Grossly hemolyzed specimen (interfering with clinical chemistry or serology).
- R5: Clotted anticoagulated whole blood (EDTA micro-clots or tube clot).
- R6: Incorrect container, anticoagulant, or collection tube used.
- R7: Exceeded stability limit or prolonged ambient transit delay.
- R8: Leaking, cracked, or biosafety-compromised primary container.
- R9: Blood collection syringe submitted with needle attached (safety violation).
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# SECTION B — SPECIMEN ID & MINOR DISCREPANCY RESOLUTION RECORD
Used ONLY for minor, reconcilable clerical discrepancies (e.g. minor spelling error, transposed MRN digit). Unlabeled or mismatched specimens cannot be confirmed and must be rejected outright (R1/R2).
| Field | Details |
|---|---|
| Date & Time Observed: | YYYY-MM-DD / HH:MM |
| Patient Name on Requisition: | |
| Patient Name on Primary Tube: | |
| Hospital Record / MRN No.: | |
| Discrepancy Nature: | [ ] Minor spelling discrepancy [ ] Transposed MRN [ ] Missing collection time [ ] Order clarification |
| Verification Action Taken: | [x] Patient chart verified [x] Ordering physician/nurse contacted [x] Collector confirmed identity |
| Ordering Physician / Nurse: | Full Name: ____________________________________ Time Contacted: _________ |
| Confirmation Sign-Off: | Attending Personnel: __________________________ Receiving MT: ____________ |
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# SECTION C — DAILY SPECIMEN ACCESSIONING & STATUS REGISTER
Date: YYYY-MM-DD | Shift: [ ] Morning (7AM–3PM) [ ] Afternoon (3PM–11PM) [ ] Night (11PM–7AM)
| Accession # | Time Rec'd | Patient Full Name | Hospital No. (MRN) | Ward / OPD | Test(s) Requested | Specimen & Tube Type | Status (Acc [✓] / Rej [R#]) | If Rejected: Clinician Contacted & Time | Recollection Agreed? | Receiving MT Initials |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | [ ] Yes [ ] No | |||||||||
| 2 | [ ] Yes [ ] No | |||||||||
| 3 | [ ] Yes [ ] No | |||||||||
| 4 | [ ] Yes [ ] No | |||||||||
| 5 | [ ] Yes [ ] No | |||||||||
| 6 | [ ] Yes [ ] No | |||||||||
| 7 | [ ] Yes [ ] No | |||||||||
| 8 | [ ] Yes [ ] No |
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# SECTION D — SECTIONAL ANALYTICAL RUN WORK SHEET
Section: [ ] Hematology [ ] Clinical Microscopy [ ] Clinical Chemistry [ ] Serology | Analyzer: ____________________
| Accession # | Patient Full Name | Test Requested | Raw Reading / Instrument Value | Dilution / Repeat | Final Verified Result | Reference Interval | Flag (Norm / Abn / Crit) | Critical Value Notified? | Testing MT Initials |
|---|---|---|---|---|---|---|---|---|---|
| 1 | [ ] Yes [ ] NA | ||||||||
| 2 | [ ] Yes [ ] NA | ||||||||
| 3 | [ ] Yes [ ] NA | ||||||||
| 4 | [ ] Yes [ ] NA | ||||||||
| 5 | [ ] Yes [ ] NA |
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# SECTION E — MONTHLY PRE-ANALYTICAL QUALITY SUMMARY & SIGN-OFF
| Summary Dimension | Monthly Metric |
|---|---|
| Total Specimens Received: | |
| Total Specimens Rejected: | |
| Overall Rejection Rate (%): | (Rejected / Received) × 100 = ______% (Target: < 1.0%) |
| Top Rejection Cause: | [ ] Hemolyzed (R4) [ ] Clotted EDTA (R5) [ ] QNS (R3) [ ] Labeling Error (R1/R2) |
Sign-Off
Medical Technologists
I confirm that accessioning, rejection notifications, and testing runs recorded above follow controlled SOPs:
- Signature: ________________________________________ Date: ____________________
Laboratory Aides
I confirm that I helped with specimen transport, receiving and accessioning, and disposal of discards:
- Signature: ________________________________________ Date: ____________________
Chief Medical Technologist / Laboratory Quality Manager
Monthly pre-analytical metrics reviewed. Rejection trends reported to CQI Committee:
- Signature: ________________________________________ Date: ____________________