final manual_nov.20,2008 edition
TRANSCRIPT
EZ Lab Manual
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INTRODUCTION
This manual summarizes policies for employees and partners/owners of EZ Lab Diagnostic & Laboratory Clinic.
This is a tool to help promote a cooperative and healthy atmosphere, to spell out policies relative to hours, wages, conditions of employment and to provide for the administration of these policies in the interests of all concerned, in keeping with conditions in our area and industry.
We are presenting this employee handbook because we feel that if you understand basically what is expected of you, and what you may expect of the company, we shall have an organization which better meets the needs of our customers.
The statements as set forth in this book have not been arbitrarily established. Each of them has a sound background of common sense based on the experiences of this company. Employees have suggested many and we will further welcome suggestions from you that will aid in maintaining a constructive and harmonious relationship.
At the time new policies or revisions are issued, they shall be incorporated into the manual. The company will post notifications of changes to the policies as they occur. In order to ensure that policy interpretations are consistent, the Office of the Human Resources or designee is solely responsible for interpreting policy application and intent. His/her interpretations shall be applicable to all pertinent situations. The Manual shall apply to all employees and partners from the time of its adoption. The company may alter, eliminate, or add to any of the provisions of the Manual at any time and for any reason, and such alterations, eliminations, or additions shall apply to all employees and partners from the time of their publication.
Our single most common goal must be to work together to meet the needs of our clients, remembering our clients are mutually our most important asset.
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FOREWORD EZ Lab Diagnostic and Laboratory Clinic is a non‐stock, non‐profit diagnostic and laboratory clinical laboratory offering leading edge testing services in the areas of clinical trials and toxicology, all under one roof at its state‐of‐the‐art facility. Strategically located at # 46 Quezon Avenue, Brgy. 1, Lucena City, EZ lab is a comprehensive and privately held laboratory operating on a provincial basis, delivering a quick, quality and convenient service at competitive prices. EZ Laboratory also offers mobile services for more convenience of our clients. Those with abnormal findings can avail of medical consultation, at discounted rates, with our doctors who are specialists and subspecialist in Cardiology, Nephrology, Pulmonology, Gastroentrology, Surgery, Obstetric‐Gynecology, and Otolaryngology.
To assure of the accuracy of our results, all examinations are performed with utmost ability, using high quality materials at the shortest possible time. That is the reason why we have devoted a reputation as a premier laboratory, especially in the area of Quezon. We even offer a money back guarantee to any proven erroneous test result.
MISSION EZ Lab Diagnostic and Laboratory Clinic’s mission is to provide a competitive advantage and fast service for its clients. They are dedicated to personalized service, the most rapid turnaround time in the industry in Quezon, innovative information management systems, and accurate testing technology.
VISION EZ Lab Diagnostic and Laboratory Clinic’s vision is to be the undisputed leader in providing customized health information services to selected markets in Quezon province in particular and the Philippines in general. GOAL
EZ Lab Diagnostic and Laboratory Clinic’s main goal is to be the undisputed leader in providing customized health information services to selected markets in the province.
• To conduct scientific, evidence‐based research from bench research to patient‐care, evaluating pharmacokinetics, pharmacodynamics, bioavailability, efficacy, clinical application, and safety.
• To develop innovative biosciences research methodologies to evaluate from randomized controlled trials to whole‐practice outcomes‐based research.
THE COMPANY: Orientation, Mission and Vision
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• To establish systems metrics of biomedical outcomes markers and natural therapies for prevention and health wellness programs.
• To disseminate clinically valuable information and scientific research about issues in Naturopathic Medicine that impacts the healthcare system.
STRATEGY
Compensation and benefit packages will support the Laboratory’s effort to recruit and retain a high‐performing and diverse work force. The laboratory will provide a high level of service to its customers by making use of available knowledge, skills and technology and through face‐to‐face interaction with those customers. All EZ lab staff and partners will fill an advocacy role, when appropriate. In filling this advocacy role, they will be mindful of the need to balance employee rights against the legitimate business needs of the company.
‐ Management‐sponsored training and development activities will be provided to enable supervisors and employees to improve their skills and abilities in carrying out their present roles and ensure safe and effective work and health habits.
‐ HR staff will provide appropriate career development opportunities to enable employees to better themselves.
‐ The HR and Management will carry out Laboratory personnel policies and procedures in an open and honest fashion, welcoming input and advice from our customers.
‐ The laboratory personnel will partner with upper management by providing professional and expert and advice and services on matters that impact upon personnel issues.
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VALUES
BECAUSE OF OUR
WE ARE ENDEAVOR TO
CLIENT FOCUS
Fulfill our clients' individual needs, creating customized solutions and providing them a competitive advantage.
COMMITMENT
Dedicate ourselves to helping each other do our best
COMPASSION
Be generous, empathic, Considerate and kind in our interactions with others
FLEXIBILITY
Be open and accommodating in our actions and decisions
INTEGRITY
Adhere to a code of ethics that promotes confidence and trust
PERSEVERANCE
Stay the course until we achieve success.
QUALITY
Exhibit and exceed the highest standards of excellence in every aspect of our lives
QUALITY
Exhibit and exceed the highest standards of excellence in every aspect of our lives
SERVICE TO HUMANITY
Enhance lives through scientific contributions, technology, and good deeds, without considering self‐interests.
TEAMWORK
Work together to achieve common goals and a meaningful purpose in our lives, and the lives of others.
COMPANY POLICIES: Values
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THE WORKFORCE: JOB DESCRIPTION AND SPECIFICATION
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GENERAL MANAGER
DUTIES AND RESPONSIBILITIES:
1. The primary duty of the General Manager is to be the direct representative capable of making sound decisions on behalf of Partners.
2. Administer the affairs of the partnership in accordance with organizational policies. Ensure the maintenance of official records, by‐laws, and standing rules according to Management Committee action.
3. Work closely with the Partners and leadership of the organized Medical Staff in developing the strategic direction and major policies of the institution. Consult with the Partners on matters concerning member issues and concerns.
4. Attend Partnership and Coordinating Committee meetings, disseminating information between governance bodies and staff, and reporting on workplace operations, finances, planning, and other matters as necessary. Ensure representation at conferences and keep the Management Committee, staff, and members informed of EZ Lab and other relevant issues and activities. Promote effective communication on all levels of the organization.
5. Research and write discussion papers, analysis documents and proposals as needed to assist the organization in determining and oversee preparation of an Annual Report summarizing progress on short and long range plans and goals. Provide leadership and vision to the organization by assisting the Management Committee and staff with the development of long range and annual plans, and with the evaluation and reporting of progress on plans.
6. Be available for employees that experience work and/or personal problems providing appropriate coaching, counseling, direction and resolution. Proactively provide information, history, continuity, support and guidance to all governance bodies and members, in conjunction with the staff team.
7. Respond to and resolve employee relations issues expressed by team members; create and maintain high quality work environment so team members are motivated to perform at their highest level. Use appropriate judgment in upward communication regarding department or employee concerns.
8. Address disciplinary and/or performance problems according to company policy. Prepare warnings and communicate effectively with employees on warnings and make effective/appropriate decisions relative to corrective action.
9. The General Manager will recruit, hire and train other personnel for permitted areas and resolve personnel problems, will handle complaints, infractions, etc., which are referred to him/her and take necessary action to resolve these situations.
10. Ensure that all staff members receive appropriate training to perform their jobs effectively.
11. Oversee administration of staff benefits.
JOB DESCRIPTION AND SPECIFICATION
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12. Be a resource for employee and guest conflict resolution. Responsible for suggesting methods to improve area operations, efficiency and service to both internal and external customers.
13. Act as arbitrator/mediator in work and personnel/personal disputes. 14. Oversee the maintenance of personnel and other administrative records. 15. Provide vision and oversight for the technology needs of the organization. Oversee
ongoing, short range and long range property management to ensure the viability, continuity and growth of EZ Lab assets.
16. Assuring the sound fiscal operation of the laboratory while promoting services that are produced in a cost‐effective manner. Analyzes and controls expenditures of the department to conform to budgetary requirements.
17. Responsible for managing the day‐to‐day operations of the laboratory and its entities. Establishing a system for assuring that high quality is provided.
JOB SPECIFICATION
1. Master’s Degree in laboratory administration, public health business administration or management, or related field is required.
2. With experience in business management, planning, financial oversight, personnel management, including hiring, supervision, evaluation and benefits administration. With experience working with a partners and committees.
3. Ability to read, analyzes, and interprets general business periodicals, professional journals, technical procedures, or governmental regulations; to write reports, business correspondence, and procedure manuals; to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
4. Ability to communicate effectively, both orally and in writing. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public; to interact, relate to, work with, and support the activities of highly qualified, dynamic physicians as individuals and members of the organized Medical Staff.
5. Demonstrated ability to manage and supervise a staff team. Ability to establish and maintain effective working relationships with staff and the general public using tact, courtesy, good judgment, media and public relations.
6. Proficiency with office computer equipment and software 7. Ability to solve practical problems and deal with a variety of concrete variables in
situations where only limited standardization exists. 8. Ability to organize and prioritize a variety of tasks and projects. 9. Demonstrated ability to share skills and knowledge with others.
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OFFICE MANAGER
SUMMARY:
Reports directly to the General Manager and maintains a close working relationship with administrative and other personnel. The office manager has both clinical and management responsibilities. S/He serves as manager, supervising personnel and developing, coordinating and managing of the business.
DUTIES AND RESPONSIBILITIES:
1. Prepare and maintain all governing body minutes, practice records and other data. 2. Monitor employees time slips (hours worked, vacation leave, sick leave, etc.). 3. Maintain payroll to include maintenance of employee record, computation of federal
and state payroll taxes, SSS, Philhealth, Pag‐Ibig Contribution and miscellaneous deductions, etc., as directed.
4. Matching invoices to packing slips and purchase orders. 5. Process and verify payment of invoices on a timely basis 6. Verification of invoices received for quantity, unit price, extensions, and discounts. 7. Prepare monthly totals of invoices, accounts payable, cash disbursements, etc., as may
be directed. 8. Forward invoices to auditor, general managers and finance committee for approval for
payment. 9. Send checks and maintains a file of paid invoices. 10. The Office Manager will also provide clerical support to other personnel. 11. Evaluates, counsels and promotes the growth and development of the clinical staff 12. Deal fairly and consistently with each employee. 13. Be accessible to, and a sounding board for, all employees. 14. Develop and recommend written personnel policies for vacation, sick leave, employee
benefits and related matters. 15. Conduct periodic reviews and evaluations of all employees. 16. Develop and implement employee training programs. 17. Establish and revise as needed job descriptions and procedures manuals. 18. Plan and Schedule office staff work assignments. 19. Keep records on all personnel of EZ Lab Diagnostic & Multi‐Specialist Center 20. S/He serves as site manager and is designated as acting administrator when the Officer
of the Month is not on site.
JOB DESCRIPTION AND SPECIFICATION
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21. Work closely with the company partners, owner, general managers to meet the company’s need.
22. Consults with and advises the General Managers regarding needs, goals, future plans and problems pertinent to clinical programs.
23. Collaborates with the General Managers to establish and maintain direction, operation practices, procedures, and standards for the organization, operation and performance pertinent to the patient.
24. Direct the overall Business Office activities. 25. Coordinate and communicate information and activities among staff, committees,
owners and any other groups within the organizational structure of EZ Lab. 26. Assures that professional and support staff properly implement clinical policies and
procedures 27. Receives visitors to office and responds to needs. 28. Recommend to the general manager maintenance needs for all office equipment. 29. Do everything possible to become a proficient computer operator. Supervise all
computer‐related procedures. Plan overall utilization of computer capabilities. Responsible to see that all changes are kept up‐to‐date. Generate reports when required by general managers or other owner of the business.
30. Provides an uninterrupted support of total office operations. Orders non‐medical supplies as needed.
31. Maintain personnel files on all personnel, owners and support/office staff, as outlined in Employee Policy.
32. Maintain records and follow‐up on items borrowed from the office, and the collection of money owed to the laboratory (i.e., personal long distance calls, wholesale purchasing cards, etc.).
33. Maintain an Office Procedure Manual so that information as to the function of the office is kept up‐to‐date and is easily accessible to others should it be needed.
34. As necessary, update any printed materials so that information is accurate and current. 35. Perform all other duties, as assigned
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JOB SPECIFICATION:
1. Degree in business or accounting and two years of related office and health care environment experience, (one year of supervisory experience) or an equivalent education/experience.
2. Must be computer literate. Proficient use in Microsoft Word, Excel and Access. 3. Must possess the ability to examine and verify financial documents and reports. 4. Must be able to prepare financial and other records in a systematic, neat, and legible
manner. 5. Must possess familiarity with clinical operating policies and procedures, insurance
industry practices, human resource management and financial/accounting principles. 6. Ability to professionally represent the physicians. 7. Excellent verbal and written communication skills. 8. Experience with customer service. 9. Strong organizational and interpersonal skills. 10. Ability to fulfill leadership role. 11. Ability to create change as needed. 12. Ability to prioritize responsibilities. 13. Must be able to work independently and without supervision. 14. Ability to maintain confidentiality of sensitive information. 15. Ability to multi‐task efficiently and effectively. 16. Takes initiative as necessary. 17. Ability to act calmly and effectively in a busy or stressful situation. 18. Requires adherence to all policies and procedures. 19. Must be able to establish and maintain effective working relationships with physicians,
managers and peers. 20. Must be able to reason, analyze, prioritize, conceptualize, make judgments, and solve
problems.
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RECEPTIONIST
SUMMARY:
This position is responsible for the professional and efficient managing of patients, visitors, clients, telephone calls and messages, then assist in clerical needs, as well as a variety of administrative and other duties that support consumer services, information and referral and the operation and presentation of a professional office.
DUTIES AND RESPONSIBILITIES:
Front Desk Reception 1. Greet patients upon arrival. 2. Receive patients at the clinic as walk‐in/follow up/referral. 3. Read and determine patients' needs by reading requests or instructions from physician
and explain to patient. 4. Fill up the request form of EZ Lab by asking patient about his/her complete name,
birthday, age and sex. Check the appropriate box requested by the physician and by the patient.
5. Determines eligibility for patients’ ability to pay. Offer the EZ Lab discount like senior citizen, loyalty card and other discounts.
6. Receive payments and issuing of patients’ receipts. 7. Submit the request form to Laboratory Assistant. 8. Typing and printing of laboratory and x‐ray result. 9. Releasing of laboratory results. 10. Post all cash on a daily basis. 11. To be responsible daily cash and check respect of consultation fees and daily collections. 12. Report and record cash collections and expenses in cash book. Verify accuracy of daily
deposit slip with cash receipts journal. 13. Maintains a complete and systematic set of records of business transactions. Balances
books and prepares reports to show receipts, expenditures, accounts payable, and various other items.
14. Record and compute referrals commission. 15. Maintain the medical records functions through pulling, filing, assembling and retrieving
patient records. 16. Working closely with the clinic assistant, ensure the smooth operation of clinical areas,
including patient flow, processing of medical records, and physician scheduling. 17. Oversee the practice computer system; work closely with consultants to maintain
current, effective hardware and software ensure data back‐up procedures, and maintain the practice website.
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18. Answers incoming calls and directs calls correctly. 19. Takes & delivers messages 20. Checks fax machine for incoming faxes & delivers to appropriate personnel. 21. Provides appropriate information and referral when necessary/requested. 22. Ensures that common areas are equipped with office supplies as needed. 23. Assist in forwarding patient files, letters and/or results to other medical centre as
requested, ensuring appropriate documentation of transfers are kept. 24. Schedule appointments for patients according to established procedures 25. Sorts and files correspondence and documents alphabetically, numerically, or by other
established classifications; removes and returns material from files; prepares file folders by subject, name or other headings.
26. Performs other related work as assigned.
JOB SPECIFICATION:
1. Graduate of Business Administration 2. One to two years medical office experience preferred. 3. Successful candidate must have excellent attention to detail, the ability to follow
instructions precisely and understand all confidentiality policies and procedures relative to medical records.
4. Have word processing experience and good organizational skills. Special skills desired for this position include knowledge of Microsoft Word, Excel and Access.
5. Excellent customer service and phone/communication skills, strong organizational abilities and the capacity to work independently.
6. Knowledge of compliance and cost reimbursement. 7. Maintains confidentiality of patient information. 8. Ability to process patients and agency inquiries. 9. Pleasant phone voice with proper grammar spoken 10. Ability to work effectively in a fast paced office environment is essential. 11. Work environment maturity and professionalism. 12. Ability to write simple correspondence. 13. Ability to effectively present information in one‐on‐one and small group situations to
customers, clients, and other employees of the organization. 14. Ability to add, subtracts, multiply, and divides in all units of measure, using whole
numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
15. Experience in cash handling and simple account management. 16. Ability to work well under pressure 17. Ability to work accurately and efficiently 18. Knowledge of patient billing procedures 19. Some knowledge of modern office practices, procedures and equipment. 20. Some knowledge of business English, spelling and arithmetic.
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21. Skill in establishing and maintaining effective working relationships with other employees, patients, clients, and the public.
MARKETING MANAGER
SUMMARY
Develops and implements strategic marketing plan for an organization. Stays abreast of changes in the marketing environment to best serve the objectives of the organization and adjusts plans accordingly. Researches and develops pricing policies and recommends appropriate sales channels. Relies on experience and judgment to plan and accomplish goals. Typically reports to management committee.
DUTIES AND RESPONSIBILITIES:
1. Make a list of target market. 2. Prepare marketing strategic plan which will appropriate to target market and will
benefits the EZ Lab. 3. Researches, evaluates prepares and/or presents customized presentations for
prospective companies which highlight business advantages to other laboratories. 4. Make a presentation or proposal and present to management committee for the
approval. 5. Deals with clients about our products and services. 6. Provides companies and communities with information relating to competitors. 7. Researches, evaluates and provides interested businesses with information on trade
opportunities, potential markets and customers. 8. Schedules and facilitates meetings and site visits for companies, clients, government
officials and dignitaries exploring business opportunities. 9. Participates in the business negotiation process; assists with the completion of
necessary paperwork. 10. Plans and schedules work activities to achieve established goals. 11. Follow up target market and responsible to have a memorandum of agreement
between EZ lab and client. 12. Prepares and submits activity reports. 13. Informs EZ Lab personnel about the schedule of his/her clients for laboratory
examination. 14. Exercises independence and initiative in the performance of assigned responsibilities;
receives general administrative direction. 15. Performs other related work as assigned.
JOB DESCRIPTION AND SPECIFICATION
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JOB SPECIFICATION
1. Bachelor in Business Administration Major in Marketing. 2. Two or more years of professional experience in marketing of laboratory services. 3. With pleasing personality. 4. Introductory knowledge of business factors affecting the marketing of EZ Lab products
and services, including trade lead sources, direct and indirect marketing, transportation, price quotation, duty requirements and product clearance.
5. Ability to prepare and present marketing and related promotional material to businesses.
6. Ability to prepare complete and concise reports. 7. Ability to establish and maintain effective working relationships with other employees,
business and trade association representatives, federal, state and local officials, foreign customers and governments, community leaders and the general public.
8. Ability to travel extensively in the performance of assigned duties. 9. Ability to communicate proficiently in a designated foreign language as may be required
for the assigned program area.
X‐RAY TECHNOLOGIST
DUTIES AND RESPONSIBILITIES:
1. Determine patients' x‐ray needs by reading requests or instructions from physician and explain to patient.
2. Determine which screen‐film combination will need. 3. Determine what size of x‐ray film and radiographic cassette will need. 4. Prepare the radiographic room or exposure room. 5. Dress patient correctly. 6. Explain to the patient what will be doing and what is expected of them. 7. Arranges patients for radiological examinations with comfort. 8. Position patient on examining table, set up and adjust equipment to view specific body
area as requested by physician. 9. Perform procedures using x‐ray equipment under supervision of physician. 10. Prevents patient from being exposed to unnecessary radiation. 11. Measure the part to be radio graphed. 12. Determine the radiographic technique to be used and set on the x‐ray machine. 13. Use beam‐restrictive devices and patient‐shielding techniques to minimize radiation
exposure to patient and staff. 14. Collimated the beam so that the only area of interest is included. 15. Identify right and left of the patient with proper lead marker.
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16. Explain that you are going to develop and view the films have been taken to determine if adequate radiographs have been.
17. Record the date, time number of films, name of patient and patient history on the requisition.
18. Properly critique radiograph. If no radiograph needs to be repeated, place in proper slot or send with proper if indicated.
19. Assist the patient. 20. X‐ray techs must observe proper safety procedures to avoid unnecessary exposure to
harmful radiation. 21. Process exposed radiographs using film processors or computer generated methods. 22. Produces radiographs (x‐rays) to aid in the diagnosis of medical problems. 23. Operate the testing equipment, develop x‐ray films, and pass them along to the
Radiologist for diagnosis.
JOB SPECIFICATION: 1. Healthcare Professionals who primarily take X‐rays and Administer Nonradioactive
materials 2. College Preferably Radiographic Technologist/X‐ray Technologist 3. At least two years of experience as a Radiologic Technologist. 4. Current PRC license with Diploma and Transcripts. 5. Has knowledge of commonly used concepts, practices, and procedures within a
particular field. 6. Relies on instructions and pre‐established guidelines to perform the functions of the job. 7. A certain degree of creativity and latitude is required. 8. Works under immediate supervision.
CLINIC ASSISTANT
DUTIES AND RESPONSIBILITIES:
1. Assists in checking vital signs, height and weight as assigned. 2. Arrange bedside unit, clinic room and equipment; assists physician with washing and
sterilizing equipment. 3. Performs related work as assigned.
JOB SPECIFICATION:
1. One or more years of experience as a laboratory & clinic assistant.
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2. Introductory knowledge of direct care procedures and techniques involved in providing basic care.
3. Ability to prepare and maintain records, charts and reports. 4. Ability to maintain patience and tact in dealing with patients. 5. Ability to take vital signs. 6. Ability to follow directions. 7. Ability to complete a basic course of patient direct care instruction. 8. Ability to establish and maintain effective working relationships with staff and
management. 9. Introductory knowledge of medical terminology.
LABORATORY AIDE
JOB DESCRIPTION
1. The main duty of the laboratory assistant will be to help with the set‐up for weekly laboratories. Cleaning up previous labs, and putting together any equipment that will be needed.
2. Assists with receipt and inspection of raw materials. 3. Miscellaneous duties may be requested as the need arises. 4. Work is performed under the direct supervision of a higher level laboratory employee. 5. Receiving of laboratory supplies and recording in the ledger. 6. Maintains a variety of laboratory records and files. 7. Keep records of chemicals, apparatus and other glass wares. 8. Returns unused chemicals to designated cabinets and cleans work area. 9. Check incoming specimens for proper identification and sufficient quantity, record
patient’s name, age, sex, date of birth. Attached lab request to samples. 10. Record daily totals of procedures performed.
JOB SPECIFICATION:
1. College, with medical background. 2. Ability to operate ECG Machine. 3. Phlebotomist 4. Willingness to perform respective laboratory tasks; 5. Ability to keep accurate records and make simple reports; 6. The work‐study should have good organizational and communication skills 7. Ability to deal effectively with staff and patients 8. Physical condition commensurate with the demands of the position.
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MEDICAL TECHNICIAN
SUMMARY:
Perform various laboratory procedures as enumerated under duties and responsibilities of Medical Technologist.
DUTIES AND RESPONSIBILITIES:
1. Draws blood and collects urine, stool, sputum and other samples for analysis as ordered by physicians.
2. Examines stained blood smears microscopically and refers any abnormal cells to superiors.
3. Performs chemical analysis. Analyses human material or other products submitted to the laboratory, using photometric, calorimetric, titrimetric, radioisotope, or any other chemical or physical procedures applicable to clinical chemistry.
4. Maintains basic records consistent with assigned responsibilities. 5. Maintains accurate records and initiates corrective action when necessary. 6. Cleans and maintains sample containers, laboratory equipment and work areas. 7. Assists in all areas of the daily operation of the laboratory. 8. Guarantees confidentiality of laboratory test results and patient identity. 9. Performs daily maintenance on analyzers and other laboratory equipment. 10. May perform and report microbiological, serological and chemical analysis on clinical
samples. 11. May perform and report hematological and chemical examinations on blood and other
body fluids for the detection and identification of communicable and other diseases. 12. Assist with collection and analysis of lab data. 13. Request and recommends the ordering of needed reagents, glass wares and equipments
to the General Manager 14. Purchase reagents and other need in the laboratory upon approval of the General
Manager 15. Monitors and ensure that all necessary supplies and equipments in the laboratory are
available and operational. 16. Responsible for keeping the laboratory equipments and apparatus in good working
condition. 17. See to it that all examination have written request before they are done. 18. Responsible for following up of send out examination and its results. 19. Updates records of laboratory results in the logbook. 20. Inform the General Manager about faulty apparatus or equipments for possible repair
or replacement. 21. Check and rechecks all laboratory results. 22. Performs various laboratory procedures such as collection, handling and preservation of
specimen.
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23. Performs blood chemistry procedures such as FBS, BUN, Uric Acid, Creatinine, Lipid Profile, SGOT, SGPT, Cardiac Enzymes, etc.
24. Performs hematological procedures such as CBC, Platelet Count, Clotting Time, Bleeding Time, ESR, etc.
25. Performs serological and blood banking procedures such as blood typing, Rheumatoid Antigen, VDRL, RPR, ASO, etc.
26. Performs clinical microscopy and parasitological procedures such as routing urinalysis, fecalysis, pregnancy test, occult blood, seminal fluid analysis, etc.
27. Reviews professional literature 28. Operational characteristics of apparatus, equipment and materials used in a laboratory. 29. General rules for safe exposure and handling of chemical and biological hazards. 30. Laboratory techniques and procedures. 31. Practices and principles of basic laboratory operations. 32. Performs other related work as assigned.
JOB SPECIFICATION:
1. Bachelor of Science in Medical Technology. 2. Five or more years as a laboratory assistant performing routine chemical. 3. Basic knowledge of chemical, biological, hematological, immunologic and microbiology
laboratory and sampling principles, techniques, procedures, terminology and equipment.
4. Some knowledge of basic science terminology, concepts and principles. 5. Some knowledge of laboratory procedures, techniques and equipment. 6. Some knowledge of blood‐drawing techniques. 7. Ability to properly operate microscopes, centrifuges, autoclaves, sterilizers or other
laboratory equipment. 8. Ability to apply proper methods of handling and disposing of chemicals and infectious
materials. 9. Ability to perform assigned tasks according to specific instructions and clearly prescribed
procedures. 10. Ability to keep routine laboratory records. 11. Ability to read, compared, identify and record laboratory data accurately, such as
names, numbers, sample descriptions, etc. 12. Ability to perform basic mathematics and make accurate measurements. 13. Ability to make accurate observations and prepare accurate records of laboratory tests. 14. Ability to operate automated analyzers and performs manual tests in accordance with
detailed instructions. 15. Ability to work with other employees, laboratory staff, health professionals and the
general public.
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16. Working knowledge of laboratory testing techniques and procedures. 17. Some knowledge of basic chemistry. 18. Skill in the use and care of laboratory equipment. 19. Ability to adhere to oral and written instructions and to make accurate observations. 20. Ability to prepare accurate records and calculate results of laboratory tests, using
standard equations or formulas. 21. Ability to perceive colors normally. 22. Ability to do work that requires meticulous and thorough performance.
MEDICAL TECHNOLOGIST
SUMMARY:
Perform most analytical tests on human body fluids and tissues providing accurate data to the healthcare team for optimal diagnosis, treatment and monitoring of disease states.
DUTIES AND RESPONSIBILITIES:
1. Performs coagulation studies on human blood and plasma. Performs chemical, macroscopic, and microscopic urine specimen examinations.
2. Maintains basic records consistent with assigned responsibilities. 3. Maintains accurate records and initiates corrective action when necessary. 4. Cleans and maintains sample containers, laboratory equipment and work areas. 5. Assists in all areas of the daily operation of the laboratory. 6. Guarantees confidentiality of laboratory test results and patient identity. 7. Performs daily maintenance on analyzers and other laboratory equipment. 8. May perform and report microbiological, serological and chemical analysis on clinical
samples. 9. May perform and report hematological and chemical examinations on blood and other
body fluids for the detection and identification of communicable and other diseases. 10. Assist with collection and analysis of lab data. 11. Request and recommends the ordering of needed reagents, glass wares and equipments
to the General Manager 12. Purchase reagents and other need in the laboratory upon approval of the General
Manager 13. Monitors and ensure that all necessary supplies and equipments in the laboratory are
available and operational. 14. Responsible for keeping the laboratory equipments and apparatus in good working
condition. 15. See to it that all examination have written request before they are done.
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16. Responsible for following up of send out examination and its results. 17. Updates records of laboratory results in the logbook. 18. Inform the General Manager about faulty apparatus or equipments for possible repair
or replacement. 19. Check and rechecks all laboratory results. 20. Performs various laboratory procedures such as collection, handling and preservation of
specimen. 21. Performs blood chemistry procedures such as FBS, BUN, Uric Acid, Creatinine, Lipid
Profile, SGOT, SGPT, Cardiac Enzymes, etc. 22. Performs hematological procedures such as CBC, Platelet Count, Clotting Time, Bleeding
Time, ESR, etc. 23. Performs serological and blood banking procedures such as blood typing, Rheumatoid
Antigen, VDRL, RPR, ASO, etc. 24. Performs clinical microscopy and parasitological procedures such as routing urinalysis,
fecalysis, pregnancy test, occult blood, seminal fluid analysis, etc. 25. Reviews professional literature 26. Operational characteristics of apparatus, equipment and materials used in a laboratory. 27. General rules for safe exposure and handling of chemical and biological hazards. 28. Laboratory techniques and procedures. 29. Practices and principles of basic laboratory operations. 30. Performs other related work as assigned.
JOB SPECIFICATION
1. Registered Medical technologist 2. Laboratory Drug Testing Analyst 3. Five or more years as a laboratory assistant performing routine chemical. 4. Basic knowledge of chemical, biological, hematological, immunologic and
microbiology laboratory and sampling principles, techniques, procedures, terminology and equipment.
5. Some knowledge of basic science terminology, concepts and principles. 6. Some knowledge of laboratory procedures, techniques and equipment. 7. Some knowledge of blood‐drawing techniques. 8. Ability to properly operate microscopes, centrifuges, autoclaves, sterilizers or
other laboratory equipment. 9. Ability to apply proper methods of handling and disposing of chemicals and
infectious materials. 10. Ability to perform assigned tasks according to specific instructions and clearly
prescribed procedures. 11. Ability to keep routine laboratory records.
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12. Ability to read, compared, identify and record laboratory data accurately, such as names, numbers, sample descriptions, etc.
13. Ability to perform basic mathematics and make accurate measurements. 14. Ability to make accurate observations and prepare accurate records of
laboratory tests. 15. Ability to operate automated analyzers and performs manual tests in accordance
with detailed instructions. 16. Ability to work with other employees, laboratory staff, health professionals and
the general public. 17. Working knowledge of laboratory testing techniques and procedures. 18. Some knowledge of basic chemistry. 19. Skill in the use and care of laboratory equipment. 20. Ability to adhere to oral and written instructions and to make accurate
observations. 21. Ability to prepare accurate records and calculate results of laboratory tests,
using standard equations or formulas. 22. Ability to perceive colors normally. 23. Ability to do work that requires meticulous and thorough performance.
JANITOR
DUTIES AND RESPONSIBILITIES:
1. Open the building at the designated time and have all front desk activities fully operational at the start of business hours.
2. Assure the readiness of the reception area for each working day including the receptionist table, front glass, water dispenser, trash can, disposable cup and other equipments.
3. Cleaning of clinic room including changing of blanket, pillow case and gown. 4. Cleaning of laboratory and drug test room including tables, refrigerator and cabinets. 5. Properly arranged the janitorial equipments. 6. Sweeping and mopping of the floor. 7. Maintains the cleanliness of comfort rooms. 8. Ordering of janitorial supplies. 9. Responsible for the maintenance of air condition and other equipments. 10. Performs a variety of minor building maintenance and cleaning tasks. 11. Secure the building at the close of each working day; turn off or unplug appliances and
machines according to company protocols and lock all entrances
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12. Works under immediate supervision. Typically reports to a manager. 13. Ability to establish and maintain effective working relationships with co‐workers,
owners, and client. 14. Performs other related work as assigned.
JOB SPECIFICATION
1. May require a high school diploma or its equivalent with 0‐2 years of experience in the field or in a related area.
2. Ability to understand and follow oral and written instructions. 3. Has knowledge of commonly‐used concepts, practices, and procedures within a
particular field. 4. Relies on instructions and pre‐established guidelines to perform the functions of the job.
MESSENGER
SUMMARY:
This is work involving the operation of a motor vehicle to transport individuals and/or a variety of supplies, products, or materials.
DUTIES AND RESPONSIBILITIES:
1. Responsible for X‐ray film & ECG Test to bring to the physician for reading. 2. Transports staff with responsibility for assisting staff. 3. Responsible to bring and deliver the documents for appropriate persons. 4. Paying of electric bill, CATV, Water Bill, Telephone Bill, Pag‐Ibig, SSS, Philhealth, BIR and
other tasks assigned by the office manager. 5. Delivering laboratory results to other medical centre as requested. 6. Verifies description and quantities of all items picked up or delivered. 7. Maintains motor vehicle and related equipment by identifying, scheduling, and/or
making needed repairs. 8. Exercises independence in performance of responsibilities; receives administrative
direction. 9. Performs other related work as assigned.
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JOB SPECIFICATION:
1. Possession of a valid driver's license appropriate for vehicle assignment at time of appointment.
2. One or more years of experience in the operation of a motor vehicle; and completion of high school level.
3. Comprehensive knowledge of the rules and regulations regarding the safe operation of motorized equipment, and of the traffic laws of the State of Philippines.
4. Ability to operate a motor vehicle safely and efficiently. 5. Ability to perform routine maintenance on vehicles and equipment. 6. Ability to maintain records and prepare necessary reports. 7. Ability to follow simple oral and written instructions; 8. Willingness to learn and perform tasks assigned; clerical aptitude; legible writing;
alertness; neat appearance; tact and courtesy; good physical condition. 9. Ability to lift, move and stack heavy objects. 10. Ability to establish and maintain effective working relationships with others. 11. Ability to understand and carry out instructions.
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COMPANY POLICIES
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POLICIES ON PROBATIONARY EMPLOYEE
PROBATIONARY STATUS
‐ The initial (6) six‐month probationary period for classified staff is served only once during continuous employment.
‐ When a temporary employee moves to a regular position within the company, he/she must complete a six‐month probationary period from the date of his/her new regular position.
‐ If an employee transfers or changes positions within the company during his/her six‐month probationary period, he/she must complete the initial six‐month probationary period.
‐ An individual who leaves the company and is subsequently rehired must complete a new six‐month probationary period.
‐ An employee may be terminated at the discretion of the company at any time during the employee’s probationary period. An employee serving the initial probationary period is not entitled to appeal or grievance rights in the event of termination of employment. Further, a probationary employee does not have access to the company’s appeal or grievance procedures for other issues relating to employment.
‐ The superior is required to evaluate the employee’s performance during the probationary period and complete at least one performance appraisal form within 30 calendar days prior to the end of the probationary period.
‐ An employee who is reclassified in his/her current position is not subject to a new probationary period.
NEW EMPLOYEE POLICIES
NEW EMPLOYEE BENEFITS ORIENTATION All new benefit‐employees shall attend an orientation session conducted by Human Resources Department. Contact the Human Resources Department for the date and time of the next regularly scheduled new employee orientation. SUPERVISORS ORIENTATION The supervisor is responsible for the orientation and training of all new employees to the job. GENERAL PROCEDURES The hiring supervisor must ensure each new employee performs the appropriate initial employment procedures.
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OPPORTUNITIES FOR INTERNAL CANDIDATES
The company seeks to provide opportunities for all employees to be considered for
promotion and/or advancement. The company believes in and is committed to a policy of upward mobility for its interested employees through promotion and transfer opportunities. JOB REFERENCES Supervisors may provide requesting employer information concerning a current of former employee’s reason for termination, job performance; professional conduct and evaluation are used for the purpose of evaluating the employee for employment. Any information provides on current or former employees shall be job‐related, truthful, factual and demonstrable from the records of the employee. APPLICANTS
An applicant is defined as someone who has completed an E‐Z Lab Diagnostic & Laboratory Clinic employment application and has submitted it in a timely manner in response to an open job posting. EMPLOYMENT ELIGIBILITY It is the company’s responsibility to ensure that the identity and the employment eligibility of all persons employed by the company have been reviewed and that they are eligible for employment. Hiring officers shall be responsible for compliance with the documentation and verification requirements of this policy. TRAINEE
A manager may also choose to fill certain vacancies with a trainee. A trainee may be hired at a rate of pay below the minimum rate of pay for that position for up to 1 month while the employee is in training. A manager interested in filling a position with a trainee should inform the Human Resources Department prior to completing the Personnel Requisition so this may be considered in recruiting efforts. However, this decision may also be made after the applicant pool has been reviewed. GENERAL POLICY
E‐Z Lab Diagnostic & Laboratory Clinic’s policy is to compensate employees on the basis
of individual performance, market, applicable governmental policies.
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PAY RATE CHANGES
Legislated Pay Raises: certain salary changes occur through state appropriations. These may include, but are not limited to, general adjustments, merit pay adjustments and market pay adjustments. Eligibility for salary adjustments is based on legislation as well as company procedures. E‐Z Lab Diagnostic & Laboratory Clinic initiated pay raises: employee Salaries may be increased through a reclassification or a salary adjustment (a Salary within the same job classification). Reasons for such adjustments may include, but are not limited to, assignment of additional responsibilities (career progression), market considerations, or equity. For classified staff and service professionals, the Human Resources Department shall determine an appropriate salary increase amount. Every year, all permanent employees are entitled to receive an additional P50 increase on his/her salary per day. ESTABLISHMENT OF PAY RATES
New Hire Pay Rates: the hiring department will establish hiring pay rates with input from the Human Resources Department. Some considerations include: experience of the applicant, responsibilities of the position, applicable salary range, market and available funding. Promotion: when an employee is promoted, an appropriate pay rate will be established, using the same consideration as in establishing a new hire pay rate. Trainee: a trainee may be hired at a pay rate below the minimum rate of pay or normal rate of pay for that position for up to 1 month. WORKING POLICIES
Expected work hours: There will be 11 hours work accomplishment per 6 days a week. 7: 00 AM to 6:00 PM. This may be modified by a manager to meet the needs of the company. The Workweek The company’s workweek consists of six days that begin on Monday and end on Saturday from 7:00 AM to 6:00 PM. The normal work schedule for full‐time employees consists of six eight‐hour work periods for a total of 48 hours worked within the company’s established workweek. This may be modified by a supervisor to meet the needs of a company.
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Reporting time/Requirements:
1. The staff is expected to be at the clinic exactly at 7AM to 6PM. 2. Signing of the attendance in logbook should be done personally. 3. The staff is required to report in major uniform.
Rest Periods An employee may have a compensable rest period of up to fifteen minutes each morning and fifteen minutes each afternoon during regularly assigned duty hours. The rest period is intended to be a recess following an extended period of work and should be followed by another work period. Rest periods may not be used to cover late arrivals or early departures from the employee’s workstation or to extend a meal period. Rest period are not cumulative and, if not taken, they are forfeited; they may not be combined to provide a thirty‐minute rest period once a day, nor may be accumulated for vacation or other time off. Rest periods must be taken at the work site. Work time may not be used to travel to another area to take the fifteen‐minute rest period. Meal Periods Employees are authorized to take a one hour unpaid meal period each work day. Emergency leaves / absences/late:
1. The staff should be informed at once in case the staff will go on emergency
leave to the head of the office. 2. All employees are required to report absences such as vacations, sick
leave, and personal time off on the Leave Application Form (LAF) 3. Relievers are allowed once Medical Technologists are absent. 4. Annual vacation leave should be filed ahead 3 days before to allow time
for the staff. 5. Prescribed form sick leaves should be accomplished. 6. All forms for leaves/absences should be duly signed by the head of the
office. 7. Personnel coming to work later than 15 minutes of duty schedule will
receive salary deduction equivalent to one hour.
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Discount:
1. 20 % discount of Senior Citizens, presentation of I.D. is required 2. 100% discount of partners and staff. 3. Immediate relatives, families and friends could avail their 10% discount of laboratory
check up. 4. The allotted budget for one year has a costs value of 6,000.00. If it is already been
consumed by the partners and staff, they are responsible for its payment. Record of Absences A (LAF) must also be completed by all employees for each absence from the workplace. Whenever possible, all absences must be approved, in advance, by the managers & officer of the month. When not possible, absences should be reported as soon as possible. Records of these absences, plus hours worked by date, must be posted to an EZ Lab Employee Time Book Record. Time Book Record Requirements Each two week pay period, must complete and sign a time record. Manager must keep records of compensatory time earned and taken, as well as current balances for each eligible employee; the EZ Lab Employee Time Book Record must be used to record hours worked, hours paid, and overtime earned. These formed will be examined in periodic audits, so it is important that they be completed and filed regularly to comply with the Fair Labor Standards Act. GENERAL INFORMATION
EZ Lab Diagnostic & Laboratory Clinic offers eligible employees a variety of benefit plans. To be eligible for benefits, an employee must be a regular employee working 40 hours or more per week for six months or more. These benefit programs are available to all company employees. Continuation of Benefits E‐Z Lab Diagnostic & Laboratory Clinic offers free medical laboratory and check‐up to all employees amounting to twelve thousand pesos (P12,000.00) for one year. The company also offers 10% discount to all relatives of the employee. Required Benefits The company is required by law to provide certain benefits for employees. Social Security, Philhealth Insurance and Pag‐Ibig are cost paid by company and employee equally.
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HOLIDAYS
Official company holidays have been designated by the President as follows:
Regular Holidays New Years Day – January 1 Maundy Thursday – Movable Date Good Friday – Movable Date Eidul Fitr – Movable Date Araw ng Kagitingan (Bataan & Corregidor Day) – Monday nearest April 9 Labor Day – Monday nearest May 1 Independence Day – Monday nearest June 12 National Heroes Day – Last Monday of August Bonifacio Day – Monday nearest to November 3 Christmas Day – December 25 Rizal Day – Monday nearest to December 30 Special Holidays Ninoy Aquino Day – Monday nearest to August 21 All Saints Day – November 1 Last Day of the Year – December 31 In the event the holidays fall on a Wednesday, the holiday will be observed on the Monday of that week. If the holiday falls on a Sunday, the holiday will be observed on the Monday that follows. The company will officially be closed for business during the Regular Holidays, and employees will receive pay for these days off. The business will be opened during Special Holidays. Eligibility for Holiday Pay All regular employees are eligible for holiday pay provided they are in pay status for the work day preceding and the work day following the holiday. Employees on sick leave are considered to be in pay status for this purpose. All unconsumed sick leave in a year are convertible to their regular day rate multiplied by five (5) days only. Holiday during Paid Leave If a recognized Company holiday falls on a regular work day during paid sick leave period, the day is paid as a holiday, and is not counted against paid leave balances. Holiday during Unpaid Leave If a recognized Company holiday falls within an authorized leave without pay period that does not exceed the duration of the normal pay period, an employee is paid for the holiday.
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If a recognized Company holiday falls on a Monday on which an employee is scheduled to return to work from an authorized leave without pay of any duration, and the employee returns to work on the holiday or on his or her next scheduled work day, the employee is paid for the holiday. Holiday Pay for Terminating Support Staff Employees If a recognized Institute holiday falls on the last available scheduled work day of a pay period, and the employee is terminating on his or her preceding work day, he or she is paid for the holiday. HOLIDAY PAY POLICIES
Holiday Pay Staff members are paid for recognized Company holidays as part of their monthly salary, when they are in pay status. Holiday during Vacation If a recognized Company holiday falls during a staff member's vacation, the day is paid as a holiday, and is not counted against vacation allowances. Holiday during Unpaid Leave If a recognized Company holiday falls during an authorized leave without pay period, a staff member is not paid for the holiday. If a recognized Company holiday falls on the day a staff member is scheduled to return to work from an authorized leave without pay of any duration, and the staff member returns to work on the holiday or on his or her next scheduled work day, he or she is paid for the holiday. Holiday Pay for Terminating Staff Members If a recognized Institute holiday falls on the last available scheduled work day of the month, and the staff member is terminating on his or her preceding work day, he or she is paid to the end of the month to include the holiday. VACATION
Full‐time employees are eligible for 15 days of vacation leave for each year. Part time employees are not eligible to vacation leave. Employees are responsible to submit leave form prior to the date of vacation leave. Managers have responsibility for coordinating and approving vacation schedules of their employees. Holiday or Illness during Vacation If a recognized company holiday falls on an employee's regularly scheduled workday during his or her vacation, the day is paid as a holiday and is not counted against vacation
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balances. Ordinarily, illness during vacation is not counted as sick leave. However, if an employee has a serious accident or illness which impairs the intended benefits of the vacation, the manager should discuss the matter with the Management Committee to consider whether sick leave should be granted, and part or all of the vacation rescheduled. As mentioned, the employee is responsible for checking the number of vacation day and then seeking permission from the manager for vacation. The employee is also responsible for informing the manager when he or she is taking days of vacation credit. Generally, the manager is responsible for recording the number of approved vacation days taken. SICK/PERSONAL LEAVE
The company grants paid sick leave to employees to guard against loss of earnings due to illness. Managers have the principal responsibility for the proper and consistent application of the sick leave policy. Abuse of sick leave in any form can have serious impact on the morale and effectiveness of all members of a group or office. Notification of Absence An employee must notify his or her manager on or before the first day of absence due to illness in order to be paid for sick leave. In cases of prolonged illness, employees are expected to keep their managers informed at regular intervals of their condition and their anticipated date of return to work, so that work may be properly scheduled or reassigned. Paid Leave for Medical Examination and Care It may be necessary from time to time for an employee to seek medical care during working hours. The circumstances of each incident determine whether the time away from the job should be paid as time worked or should be charged to sick leave balances. Medical Certification The manager is responsible for the equitable administration of the company's sick leave policy, and may require medical certification from an employee's (or family member’s) physician indicating that the employee is unable to work because of the employee’s or family member’s illness, before the sick leave is paid. Illness during Vacation Ordinarily, illness during vacation is not counted as sick leave. However, if any employee has a serious accident or extensive illness which destroys the intended benefit of the vacation, the manager should discuss the matter with the Management Committee to consider whether sick leave should be granted, and part or all of the vacation rescheduled. Sick Leave for Disability Associated with Pregnancy or Childbirth Disabilities associated with childbirth will be treated as any other disability with regard to payment for sick leave in accordance with applicable sick leave policies.
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Amount of Sick Leave Full‐time and part‐time employees will be credited with 15 days of sick leave on the employee's anniversary date of each year, provided that they have completed at least six months of service at the Company. Sick leave is paid at normal rates and must be reported on attendance records. Use of Sick Leave Sick leave is to be used in cases of accident or illness of the employee, and medical or dental examination and care. In addition, an employee may use up to fifteen days of sick leave every year to care for a sick family member, such as a child, spouse, parent, parent‐in‐law, or other member of the household, and for their medical or dental examination and care. Holiday within Sick Leave If a recognized company holiday falls on a regularly scheduled work day during a paid sick leave period, the day is paid as a holiday, and is not counted against sick leave allowances. PERSONAL LEAVE POLICY
Personal Leave for Support Staff
E‐Z Lab Diagnostic & Laboratory Clinic’s policy on personal leave is intended to provide Staff with flexibility in their work situations by allowing to accommodate personal needs which otherwise would have to be charged to vacation balances. ON ABSENCES AND LEAVE
Notice of Absence
In keeping with other leave policies, Staff will be required to obtain the approval of their managers to be absent on personal leave on a given day or part of a day. It will normally be expected that employees will obtain this approval at least three working days in advance of the planned absence. No explanation of the reasons for the absence will be required except when emergency situations cause employees to seek approval for absences on shorter notice. Personal leave may be taken in less than full‐day periods and should be reported to the nearest quarter of an hour. Leave Related to an Employee's Own Serious Health Condition (Including Pregnancy and Childbirth)
In the case of an employee's own serious health condition, including conditions related to pregnancy and childbirth, leave may be approved in continuous periods, intermittent periods, or by a reduced work schedule, in accordance with certification from the employee's health care provider. In cases of reduced schedules or intermittent leave, a manager may transfer the employee temporarily to an alternate position to accommodate the needs of the
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work area. Leaves which extend beyond 12 weeks in duration due to an ongoing serious health condition will be reviewed on a case‐by‐case basis in accordance with EZ Lab’s general sick leave policies as outlined on this Manual.
Sick leave policies for the particular payroll category should be reviewed in determining any paid leave for which the employee is eligible. If an employee is not eligible for paid leave, or if paid sick leave benefits have been exhausted, the leave period will be administered as unpaid leave.
Following a medical leave period related to pregnancy and childbirth, an employee may be eligible for additional leave, without pay, for purposes of child care. In such cases, the combination of the medical leave period and the additional period for child care leave should not exceed 12 weeks in total. Leave to Care for the Employee's Newborn Child
Leave to care for a newborn is unpaid leave. Following a sick leave period related to pregnancy and childbirth, an employee may be eligible for additional leave, without pay, for purposes of child care. In such cases, the combination of the medical leave period and the additional period for child care leave should not exceed 12 weeks in total. Requests for leave to exceed 12 weeks will be reviewed in accordance with the specific circumstances of the request, considerations of work coverage, and the provisions of the Company's general policy on leave without pay. Leave to Care for a Family Member with a Serious Health Condition
Employees may request leave in situations where they are required to participate in the care of a seriously ill child, parent or spouse. Requests for leave to care for other seriously ill family members or members of an employee's household may be considered on a case‐by‐case basis.
An employee may request leave in continuous periods, intermittent periods, or by a reduced work schedule to a total of 12 weeks, in accordance with certification from the family member's health care provider. In cases of reduced schedules or intermittent leave, a department supervisor may transfer the employee temporarily to an alternate position to accommodate the needs of the work area.
Leave periods to care for seriously ill family members are unpaid leaves. Requests for leave to exceed 12 weeks will be reviewed in accordance with the specific circumstances of the request, considerations of work coverage, and the provisions of the Company's general policy on leave without pay Request and Authorization of EZ Lab Leave
Employees are expected to provide as much advance notice of the need for leave as is possible to allow for planning of coverage in the work area. Notice of at least two weeks is
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preferred. Leave of Absence Authorization forms are available in the Office.
In addition, certification from a qualified health care provider will be required for approval of a leave to care for a seriously ill family member or in the case of an employee's own serious health condition. Such certification should be provided prior to the beginning of the leave (or in as timely a manner as possible) and should include: the date on which the illness/condition commenced; the estimated duration of the illness/condition; a statement that the illness/condition warrants the participation of the employee to provide care (in the case of an ill family member); and, in cases in which intermittent leave is advised, the dates and duration of treatments to be given. Copies of the Certification of Health Care Provider form are available for this purpose. ON ACCIDENT & COMPENSATION
Industrial Accident and Worker's Compensation
The company provides insurance to protect employees against financial loss due to personal injury and some occupational illnesses arising out of and in the course of employment at the Company. Reporting a Laboratory Accident
An employee who has been injured or becomes ill as a result of his or her employment at the Company should notify his or her manager at once, and seek immediate medical attention. The manager must also submit a written report of the illness or injury that occurred. BEREAVEMENT LEAVE
Eligibility
Bereavement leave policy is designed to provide employees with paid time away from work to grieve and to handle matters related to a death in their family. All full‐time employees are eligible for bereavement leave. Length of Bereavement Leave
In the event of a death in an employee's family, after discussion with his or her manager, the employee may be granted up to five days of paid leave for bereavement. A day of bereavement leave is based on the standard workday the employee would have worked on the day(s) taken for bereavement. Payment of Holiday Pay
An employee will be paid for a holiday which falls during a period of absence due to an occupational injury or illness only if he or she is supplementing his or her wage replacement
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benefits with sick leave. In this event, the portion of supplemental pay normally charged to sick leave will be charged to holiday pay. Review of Employment Status
In cases of prolonged absence due to an occupational illness or injury, the employment status of the individual will be reviewed periodically, and may result in termination of employment with the Company. LEAVE OF ABSENCE WITHOUT PAY
Approval of Leave without Pay
Leaves of absence without pay may be granted for a specified period of time, normally for educational or public service reasons and because the Company wishes to maintain an association with the individual. A manager may authorize an individual to take, in any calendar year, unpaid leave of duration not to exceed the individual's normal pay period. Requests for leaves must be approved by the managers.
Eligible staff members are entitled to a leave of absence without pay of up to 12 weeks in a 12‐month period to care for their newborn child or a child newly placed with them for adoption or foster care; because of the serious health condition of their child, parent, or spouse requiring their participation in care; or because of their own serious health condition, including conditions related to pregnancy and childbirth. Request for Leave without Pay
A request form for Leave of Absence Authorization, available from the Office of Personnel Services should be completed at least two weeks prior to the anticipated beginning of a leave without pay. All signatures necessary for authorization of the leave must be obtained by the employee before the form is forwarded to the Office of Personnel Services for final approval and processing. The form contains specific instructions for its completion.
One copy of the signed form is returned to the department in which the employee works, one copy is returned to the employee, and one becomes part of the employee's personnel file in the Office. PAYMENT
‐ An eligible employee who worked during Special Holiday will be paid at the rate
of 130% of his/her salary. ‐ Holidays falling within a vacation or sick leave period will be treated ad holidays;
therefore, they will not be charged to vacation or sick leave. ‐ Upon termination, an employee will be paid any holiday pay that he/she had not
received and for which he/she was eligible.
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Accommodation of Religious Observances/Practices No employee shall discriminate against any employee or other individual because of such individual’s religious belief or practice or any absence thereof. Furthermore, a manager is responsible to reasonably accommodate individual religious practices. ELIGIBILITY
‐ Regular employees working 40 hours per week or more for a continuous period
of six months or more are eligible to use vacation. However, employee is not eligible for vacation pay.
Carry Forward of Accrued Vacation
An employee is encouraged to use his/her vacation hours each year, rather than permitting vacation to accumulate. Unused vacation leave may be accumulated and carried forward from one calendar year to the next. Time Charges
‐ All employees are required to complete a Record of Absence (ROA) form for all vacation and sick leave taken.
‐ Sick leave while on vacation is authorized only when the employee has a major illness or injury and is unable to continue the vacation activity. A physician’s written statement may be required to verify such an illness.
‐ Holidays falling within a vacation period will be treated as holidays and therefore not be charged to vacation leave.
ON VACATION
SCHEDULING OF VACATION TIME An employee must request approval to use vacation time in advance of taking time off. Scheduling of vacation time will be the responsibility of the manager concerned. While vacation will be granted, whenever possible, to satisfy individual requests, continuity of operations must be maintained. Consequently, vacations must be scheduled in accordance with the requirements of the company for the employee’s services. REPORTS AND RECORDS Managers are responsible for recording and maintaining accurate records of vacation taken by their employees. This responsibility includes timely reporting of hours taken and monitoring accruals. A company timekeeper may be assigned to assist a manager in this task but it remains his/her responsibility.
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ELIGIBILITY ‐ Regular employees working 40 hours per week or more for a continuous period
of six months or more are eligible to accrue and use sick leave. ‐ Temporary employees are not eligible for paid sick leave.
CONDITIONS OF USAGE
‐ Sick leave benefits are designed to provide for continuation of income during
times of legitimate illness. Sick leave is not to be considered as an alternative form of vacation time, holiday leave, or time off personal business.
‐ An eligible employee may be granted sick leave when he/she is unable to perform his/her duties because of illness, injury, pregnancy, childbirth, or because he/she must be absent from work for the purpose of obtaining health‐related services not available after regular working hours.
‐ Sick leave may be granted to an eligible employee whose absence is due to illness or communicable disease within the employee’s immediate family or household. Immediate family is defined as a parent, parent‐in‐law, brother, sister, spouse, child, grandparent, grandchild, and any other person who is a permanent member of the employee’s established household.
‐ Sick leave shall not be allowed for absence due to any of the following:
1. Disability arising from any sickness or injury purposely self‐inflicted or caused by the employee’s willful misconduct.
2. Sickness or disability while on layoff status, leave of absence without pay, or vacation, except when the employee has a major illness or injury and is unable to continue the vacation activity. A physician’s written statement may be required to verify such an illness.
3. Sick leave should be requested and approved in advance, when possible. Sudden illnesses that result in absences must be reported to the employee’s manager within three working days after an employee’s return from illness. In situation where an employee is unable to complete a Record of Absence form to meet bi‐weekly deadlines, the manager may complete the form for the employee to ensure continuity of pay.
4. For absence in excess of three days because of illness, injury, or other disability, or should there be reason to believe that sick leaves is being abused, the employee may be required to furnish the company with a written statement from a physician must also certify that the employee is able to return to work. In the event the manager exercises this option, the employee will not be permitted to return to work without this physician’s statement.
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REPORTING AND RECORDKEEPING
‐ It is the employee’s responsibility to submit an accurate Record of Absence form
reporting the hours he/she did not work for which sick leave is requested. ‐ It is the manager’s responsibility to record and maintain accurate records of sick
leave taken by his/her employees. This responsibility includes timely reporting of hours taken and monitoring accruals. A department timekeeper may be assigned to assist a manager in this task but it remains the manager’s responsibility.
PAYMENT
‐ Payment for sick leave approved and taken is made at the employee’s straight‐time rate of pay for time lost within the regularly scheduled work period.
‐ If a holiday falls within a period of approved sick leave, it is charged as a holiday, not a sick leave time.
RETURN TO WORK
‐ The employee will be returned to his/her former or essentially equal position upon returning from leave. If the leave is based on medical needs, the employee is responsible for providing adequate documentation to support return to work and/or fitness for duty.
‐ If a company head has the reason to question the capacity of an employee to perform duties and responsibilities, the company head may choose to require the employee to be examined by a physician of the company’s choosing for a “fitness for duty” examination.
FAILURE TO RETURN OR ACCEPT EMPLOYMENT
An employee will be considered to have voluntarily terminated employment if he/she:
a) Fails to return to work upon the expiration of the Extended Leave of Absence or date agreed upon,; or
b) Fails to contract his/her company head two weeks prior to the end of the Extended Leave of Absence to request an extension (if applicable); or
c) Advises the company of his/her intention not to return to work.
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ABSENCE WITHOUT PAY Absence without pay is use for temporary absences only and may be used for up to one
pay period’s worth of time for one event. ‐ Requests for absence without pay must be made in advance and must have the
approval of the manager and the company head. EMPLOYEE PERSONNEL RECORDS MANAGEMENT
OFFICIAL PERSONNEL RECORDS The Human Resources Department maintains an official personnel record for probationary and regular employees. CONTENTS OF OFFICIAL AND OTHER PERSONNEL RECORDS
Typically, each employee’s official personnel record contains the following: 1. All job application forms, resumes, vitae, transcripts, letters of reference and
other employment‐related documents submitted to the company. 2. Copies of all performance appraisal reports for classified staff and service
professionals. 3. A chronological file, record, or copies of approved personnel action forms,
memoranda, or other documents that reflect authorized changes in employment status, salary, etc.; when such documents are available.
4. Official correspondence with or about the employee, including any letters of recommendation, reprimand, or employee comments concerning statements contained in the file.
5. Documents acknowledging or verifying receipt by an employee of disciplinary communications. (Warning, either verbal or written, is not considered disciplinary communications.)
6. Documents, certificates, diplomas, etc., related to further education, trainings and certification completed by the employee.
7. Any other document, form, letter, memorandum, agreement, etc., that is deemed by the Director of Human Resources to be an employee record that should be placed in the official personnel record.
PROCEDURE FOR VIEWING EMPLOYEE FILES
If an employee wishes to view the contents of his/her Human Resources Department file, he/she should set up an appointment to do so with a representative of the Human Resources Department. The employee should not assume that the staff member will make copies of any items in the file during this viewing, but may request specific copies to be picked up at a later date. A charge may be made for copies.
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PERSONNEL STATUS CHANGE ‐ An individual employee and his/her supervisors should keep the Human
Resources Department informed of any changes in personal status (i.e.; marital, number of dependents, etc.). Any births or deaths in an employee’s family or a change in marital status may affect the employee’s income tax withholding. An employee may add dependents to his/her life insurance policies; if the Human Resources Department is notified within 30 days of the date such dependents first become eligible. Designated beneficiary changes can be made at anytime and should be reported to the Human Resources Department.
‐ A change in name, address, telephone number, emergency contact name, and/or address should be reported to the Human Resources Department immediately. It is important in emergency situations that current information be available.
‐ Contact the Human Resources Department for assistance and clarification on benefits.
INQUIRIES REGARDING CURRENT OR PAST EMPLOYEES
‐ The Human Resources Department is the official source of information regarding present or former employees.
‐ Employment verifications requested by banks, or other financial institutions should be referred to the Payroll Officer.
‐ A copy or written communications regarding verification of past employment must be sent to the former employee’s last known address. This will include both the information requested and supplied.
EMPLOYEE DEVELOPMENT AND TRAINING PROGRAM
The company is committed to employee professional development. In an effort to accomplish this, the Human Resources Department sponsor a broad range of program opportunities including workshops, seminars, classes and comprehensive courses of study. MANDATORY TRAINING
‐ Managers are required to allow classified staff and service professional employees to participate in career and professional development programs each fiscal year and to support developmental leaves for those employees participating in these programs. Time taken to attend workshop must be approved in advance by the managers. While all managers are encouraged to allow employees off from work to enhance professional development, continuity of operations must be maintained. With prior manager approval, employees shall be allowed to use work time rather than take vacation time or leave without pay to attend training programs related to their job.
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‐ Government legislation mandates that company heads ensure all employees (regular, temporary, and student workers) receive Public Service Orientation (Ethics) training at least once every two years. Employees must attend Safe Working and Learning Environment training at the beginning of employment.
RECOMMENDED TRAINING
Managers should participate in programs regarding cultural diversity, affirmative action, performance appraisals, and general management/supervisory issues to gain perspective on the company’s policies and philosophies in these important areas. Managers are encouraged to contact the Human Resources Department for more information. PERFORMANCE REVIEW GUIDELINES
In work performance discussions, the following topics are useful for both managers and employees and should be the basis of a discussion at once a month. Ideally, communication and feedback exist continuously between officer of the month and employee. However, even when feedback is freely given and received, a more formal annual or semi‐annual performance review is desirable. It is the manager's responsibility to see to it that performance reviews take place with all employees. It is important for both managers and employees to have considered the following elements prior to the actual performance review discussion and be prepared to discuss them. CLASSIFIED STAFF PERFORMANCE APPRAISALS
APPRAISAL SCHEDULE
‐ The performance of each regular employee will be appraised at least once a year. Classified staff appraisals are due to the Human Resources Department between November 1 and January 31. The Human Resources Department staff may notify the appropriate administrative levels of delinquent performance appraisals. An employee may be evaluated more frequently at the manager’s discretion, or at the employee’s request.
‐ Anytime an employee’s performance changes significantly, a new performance appraisal from should be completed and submitted to the Human Resources Department.
PROBATIONARY PERFORMANCE APPRAISALS
All newly hired classified staff employees will receive a probationary performance appraisal due within 30 calendar days prior to completing six months of continuous service. After the probationary period is completed, all classified staff will receive an annual appraisal
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due to Human Resources by November 30 of each year. A probationary employee will serve a minimum six month probationary period.
If a manager permits the employee to work beyond the six month probationary period without a formal appraisal to the Human Resources Department that employee may request an appraisal but shall not be moved to a regular status automatically. Employees transferring between branch or positions without a break in service shall not serve a second probationary period. EMPLOYER RESPONSIBILITIES
The company is responsible for providing an environment reasonable free from hazards
that may cause illness, injury, or death to employees, patients and visitors. As such, the Company will:
b. Establish and maintain safety and loss prevention/risk management programs that seek to protect human health, to ensure regulatory compliance and to preserve company interest and assets.
c. Incorporate educational programs and training designed to prevent accidents and injuries, monitor procedures to identify hazardous situations, and take corrective actions to eliminate known deficiencies.
d. Comply with applicable Federal, State, Country, and local safety laws and regulations.
e. Maintain an incident management plan that seeks to reduce risk to the health and safety of the company community in the event of an emergency.
EMPLOYEE RESPONSIBILITIES All employees are responsible for maintaining a safe environment through their work and other actions. As such, employees are required to:
1. Comply with applicable governmental laws and regulations. 2. Observe all company rules and regulations related to the efficient
and safe performance of their work. 3. Attend assigned training to promote safety and minimize risks. 4. Report to manager and/or correct hazards, unsafe equipment, and
improper work practices, as appropriate. 5. Report to manager accidents/injuries that occur to themselves or
others while on the job or on company property. 6. Report to police office and crimes and/or acts of violence or
threats of violence. 7. Operate company or personal vehicles while on company business
in accordance with transportation guidelines and applicable state and local laws.
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MANAGER RESPONSIBILITIES
All company employees who supervise others are responsible for maintaining a safe work environment by ensuring that:
1. Employees are trained in basic safety measures, fire and fire hazard prevention, and emergency evacuation procedures. Managers should ensure that job‐specific safety training is identified and assigned to employees. This training may include proper handling of chemicals and biological agents, and other types of training.
2. Safety training records are maintained for their employees. 3. A manager report of injury is filed when an accident or work‐related health
problem or injury occurs in their area of responsibility. 4. Equipment and property within the area of responsibility are maintained in a
safe condition. 5. Employees are required to follow safe work practices at all times. 6. If an employee violates safe work practices or procedures, the unsafe
behavior is halted, the employee is informed of the infraction(s), and the correct method of work is reinforced. Discipline for failure to perform work in a safe manner will depend on the severity of the incident and will range from verbal reinforcement of safe working procedures, up to and including termination.
Smoking is defined as the carrying or use of lighted pipes, cigars, cigarettes, snuff, or tobacco in any form. POLICY
1. Smoking is prohibited in EZ Lab building. 2. Smoking is prohibited inside all company‐owned vehicles. 3. Complaints or concerns regarding violations of this policy or disputes regarding its
implementation should be referred to the manager for resolution. 4. Violators of this policy may be subject to disciplinary action.
ALCOHOL/DRUG POLICY
1. Any violation of the drug/alcohol policy can result in disciplinary action up to and including termination.
2. EZ Lab Diagnostic & Laboratory Clinic requires that company employees report to work in a condition to perform their duties safely and efficiently in the interest of their co‐workers and patients, as well as themselves. For these reasons, the use of illegal drugs and alcohol is prohibited during work hours at the company workplace, while occupying company vehicles, while on company business and during working time.
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3. All state, federal, and local laws and company regulations pertaining to alcohol and other drugs apply to all members of the company community including employees, partners and guests.
ALCOHOL POLICY
1. Alcohol beverages may not be sold or consumed on property owned or controlled by the EZ Lab System except when permitted by the general manager of the respective company or designee in compliance with applicable laws.
2. Company employee or guest will be responsible for the regulations found in the policy manual.
3. No person may consume or be under the influence of alcohol while attending and fulfilling employment responsibilities. Employees must conduct themselves in a responsible and professional manner at all times.
DRUG POLICY
24. Possession, use, sale, manufacture, transfer or cultivation of any types of controlled substances (to include, but not limited to, barbiturates, opiates, marijuana, amphetamines, or hallucinogens) or aiding in the use of such, violates the laws of the Philippines.
25. Use of illegal drugs or the use of prescription medication or over the counter drugs is dangerous and unacceptable behavior in the company community and is prohibited.
26. Use or possession of any controlled substance or illegal drug or paraphernalia for illegal drug use, and the unauthorized distribution or possession for the purpose of distribution of any controlled substance or illegal drug is prohibited.
27. Company employees must report to the General Managers any criminal drug statute conviction for a violation occurring in the workplace no later than five working days after such conviction.
REPORTING VIOLATIONS OF THE ALCOHOL/DRUG POLICY Complaints made by company employees and/or guests about a company employee should be reported to the employee’s immediate manager. EMPLOYEES SUBJECT TO TESTING
Any company employee (regular full‐time or part‐time, temporary or student employee whose job description involves a safety‐sensitive function or requires possession of a commercial driver’s license for employment purposes, is subject to drug and/or alcohol testing.
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SUBSTANCE TO BE TESTED
Substances to be tested for under this policy are: 1. Breath alcohol concentration 2. Controlled substances (to include but not limited to) cocaine, marijuana, opiates (including heroin) amphetamines, and phencyclidine. In accordance with government regulations:
1. No employee shall be on duty while possessing or consuming alcohol. 2. No employee shall be on duty while possessing, using, or exhibiting any trace of
controlled substances in the body. 3. No employee shall report for duty or remain on duty requiring the performance
of safety‐sensitive functions while having a breath alcohol concentration. Safely‐sensitive functions are defined as those which could endanger the life of the employee, other employees, patients, or members of the public.
4. No employee shall report to duty within a minimum of four hours after consuming alcohol.
ALCOHOL AND CONTROLLED SUBSTANCE TESTING REQUIRED
1. Pre‐employment – Testing shall be administered after an offer to hire has been made and prior to an employee actually performing safety sensitive functions for the first time. Testing is also required for employees who are transferred/promoted into a classification requiring a commercial driver’s license. All applicants who refuse or fail to pass a pre‐employment drug and alcohol test will result in the employment offer being withdrawn.
2. Post‐accident – Testing shall be administered after an accident has occurred where the employee received a moving traffic citation and after every accident involving a fatality, regardless of who was at fault. Testing shall occur within a minimum of two hours, but not to exceed an eight hour period following the accident.
3. Reasonable Suspicion – Testing shall be administered when a manager has a “reasonable suspicion” that employee(s) are in violation of the alcohol/drug policy, the employee(s) will be referred to the testing site immediately.
4. All testing are coordinated by the General Managers. CONSEQUENCES OF TESTING REFUSAL
1. New Hires – who refuse pre‐employment testing, or fail to appear for testing will have
the job offer withdrawn unless valid medical documentation is presented to the manager in advance or no later than one working day following the scheduled test.
2. Employees – who refuse testing, unless valid medical documentation is presented to the manager, will receive disciplinary action up to and including termination.
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DEFINITION OF FITNESS FOR DUTY EVALUATION
An evaluation made by a physician, psychologist, or other evaluator to determine whether an employee is able to continue in the performance of all essential functions of his/her job with or without reasonable accommodation. GENERAL GUIDELINES
1. Each employee is responsible for maintaining his/her health in such a way that the employee can perform the essential functions of his/her job with or without reasonable accommodation. If a manager has reason to question the capacity of an employee to perform duties and responsibilities, a Fitness for Duty Evaluation may be required.
2. To determine the appropriateness of a formal Fitness for Duty request, the manager must consult with the company physicians.
3. If assistance is needed in working through manager and employee relationship problems, or if there are concerns about the emotional or behavioral impact of a Fitness for Duty Evaluation requirement on an employee, or more immediate concerns about the employee’s emotional/behavioral condition, the General Managers may be consulted.
4. If the company requires a Fitness for Duty Evaluation, the employee will be required to be examined by an evaluator of the company’s choosing at a predetermined time and location. The company will pay the full cost of the examination. Failure to attend a Fitness for Duty Evaluation may lead to disciplinary action, up to, and including, termination.
5. Records, reports and results of such an Evaluation will be maintained confidentially and separately from the employee’s official personnel record. The report is and will remain company property.
6. Time required by the employee to complete the Fitness for Duty Evaluation is considered as company work time and may require an administrative leave. Time off for prescribed treatment (after the Evaluation), mandatory or otherwise, will be charged to accrued sick leave.
7. For absences in excess of 2 weeks the employee may be required to be on a leave status. The purpose of this policy is to cooperate with state and local officials in the lawful collection of garnishments and resolution of complaints and court orders.
8. All employees are expected to conduct their private business affairs in a manner that will not bring discredit to the company. The company will not serve as agent for the collection of indebtedness claims against employees. Therefore, only those claims that have undergone due process of law will be honored.
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COMPLAINTS
1. Complaints against an employee for reasons unassociated with his/her employment by
the company will not be considered. 2. Telephone complaints of collectors are not to be knowingly referred to an employee. 3. Complaints, claims or requests for collection assistance received by the company head
or manager will be referred to the Finance Committee for reply. POLITICAL ACTIVITY
1. Employees may participate in political activity outside their employment, but shall not allow their interest in a particular party candidate, or political issue to affect the performance of their company duties, or interfere with other employees’ timely completion of their company responsibilities.
2. An employee shall not, directly or by implication, use the name of the company or his/her affiliation with the company in the endorsement of political candidates, initiatives, referenda, or in supporting or opposing a position on other political issues.
3. An employee who plans to campaign for public office or who is elected to public office should request a personal leave of absence, if his/her candidacy or public office prevents him/her from being available to perform his/her assigned duties and responsibilities.
4. The use of company resources, including mail, e‐mail or web sites, for the purpose of attempting to promote or defeat the election of a candidate for public office, or the passage or a ballot measure is prohibited.
SOLICITATION
Solicitations are to be discouraged on the company, unless an employee is acting for a
charitable or service organization, and then such solicitation is not to be done during work hours of either the solicitor or the solicitee and with the understanding that the company reserves the right to cancel all solicitation privileges. DRESS CODE
1. Department heads shall have the right to prescribe certain reasonable standards of dress and appearance of their employees. These standards may be established to ensure the safety of employees, to maintain an appearance of neatness and cleanliness among employees, or to further other purposes related to conducting company business.
2. Department heads that wish to establish a departmental dress code are encouraged to consult with a General Manager. Dress codes must be communicated to all employees
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LABORATORY SAFETY
In addition to the hazard communication training, all laboratory employees must receive
annual laboratory safety training. Basic laboratory safety rules are as follows. 1. No running, jumping, or horseplay is permitted in laboratories. 2. All biohazardous, hazardous, and radioactive materials must be properly labeled and stored. Use flammable and acid storage cabinets and explosion‐proof refrigerators when required. 3. Stairways, hallways, exits, and access to emergency equipment such as fire extinguishers, safety showers, and eyewash fountains must be kept clear. 4. No eating, drinking, applying cosmetics, or smoking is allowed in areas where hazardous materials are stored or used. 5. Always thoroughly wash your hands before eating or smoking, on completion of work. 6. Do not store food or drinks in refrigerators, freezers, or containers designated for chemical, biohazardous, or radioactive storage. 7. Compressed gas cylinders must be secured at all times, including during transport and when empty. Cylinder caps must be in place when the cylinder is not in use. 8. Do not work alone in a laboratory if the procedures being conducted are deemed hazardous by the laboratory supervisor. Assure that at least two people are present at all times if a compound in use is highly toxic or of unknown toxicity. 9. Laboratory coats and other protective clothing worn in the laboratory area are not to be worn outside the laboratory. 10. Sandals, open‐toed, or open‐heeled shoes should not be worn in the laboratory. 11. Never dispose of a hazardous, biohazardous, or radioactive substance down the drain or in the trash unless you have been specifically authorized to do so. 12. Radioactive material usage areas and animal facilities must have controlled access that is strictly enforced. Laboratory areas should not be left unattended unless the area has been secured. 13. Report any accidental exposure (inhalation, ingestion, skin contact, or injection), injury, or spills to your supervisor immediately.
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CLOTHING
Unless the worker is wearing a laboratory coat, loose or torn clothing should be avoided due to the potential for ignitability, absorption, and entanglement in machinery. Dangling jewelry and excessively long hair pose the same type of safety hazard. Tight rings or jewelry which cannot be easily removed should be avoided because of the danger of corrosive or irritating liquids producing skin irritation. Laboratory coats should be worn at all times in the laboratory area when infectious or chemical hazards are present. Laboratory coats and other protective clothing worn in the laboratory area should not be worn outside the laboratory. Shoes must be worn at all times when working with hazardous or infectious materials. Sandals, open‐toed shoes, or perforated shoes should not be worn. Gloves Many hazardous materials can be absorbed through the skin. Others, such as organic solvents can dissolve the natural protective oils on the skin, leading to chapped and cracked skin and the possibility of infection. Therefore, protective gloves must be worn when a potential skin exposure exists or where there is a potential for accidental spills or contamination. Be sure to select the right glove for the task at hand. There is no glove currently available that will protect against all chemicals. Read the label, MSDS, or literature provided by the glove manufacturer to ensure that the proper glove has been chosen. Before each use, gloves should be inspected for discoloration, punctures, and tears. If the gloves become contaminated, they should be removed and discarded as soon as possible. Always wash your hands immediately after removing gloves. Always remove gloves before leaving the immediate work site to prevent contamination of door knobs, light switches, telephones, etc.
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Laboratory Standard Operating Procedures
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PROTOCOLS
a. Specimen handling I. Receiving‐to include walk‐in and send‐in specimens from other labs.
1. The specimen is received by the laboratory staff from the receptionist. It should be always accompanied by a request. The requesting data are entered in the logbook. It should include the complete name of patient the first name, middle name, surname, age, birthday, sex and Official Receipt (OR) Number.
11. Recording
Result of examinations are recorded in their corresponding logbooks as well as on laboratory result forms.
111. Rejection criteria – for adequacy and inadequacy
a. Specimen rejection. 1. All quantity not sufficient specimens “QNS” 2. For Urine 1 hour of collection after voiding, it should be 30 minutes after
voiding. 3. Stool after 1 hour of collection is rejected 4. Hemolyzed serum for electrolytes examination and chemistry
examination. 5.
CRITERIA OF SPECIMEN
SPECIMEN ADEQUACY INADEQUACY
Urine approximately 5 ml less than 2 ml
Feces marble size very negligible amount
Blood fresh drop or good smear too thin, with ridges
Waves and holes smear
IV. REPEAT TESTING
1. Repeat testing is done upon the request of the physician. 2. When error signals are displayed in the apparatus the test is
repeated. 3. When results are abnormally high or low repeat testing is done.
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IV. RELEASING OF RESULTS
1. Double‐checking of result is done by the RMT before releasing to the client.
V. SEND‐OUT
1. Examination that are not available in our laboratory are send to MT. GILEAD pick up by their messenger.
2. Histopath and papsmear are picked up by the secretary of pathologist daily.
3. All send‐out results are also entered in there respective logbooks. VI. COURTESY REQUEST
1. If ever there is any courtesy request it will be known and address to the owner for approval.
2. All courtesy or “paki” should be approved by the management before it will be done.
VII. REFERRALS TO HEAD OF LABORATORY.
1. Any breakdown, malfunctioning and repairs of major apparatus and equipments are always referred to the head. 2. When there is emergency run out reagent or supplies request is made from other laboratories.
b. Procurement I. Supplies
1. An ordered slip of supplies is accomplished by the purchasing, for the approval of the head then prior to booking by the sale representative.
II. Reagents
1. An ordered slip of supplies is accomplished by the purchasing for the approval of the head prior to booking by the sale representative. 2. Inventory of all stocks of reagents is updated regularly.
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WASTE MANAGEMENT PROGRAM
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D. HANDLING OF COMPLAINTS, LABORATORY ACCIDENTS AND INCIDENT REPORTS. 1. All complaints maybe address verbally or with written communication to the
head. 2. An investigation will be conducted to confirm the validity of such complaint.
CONTINGENCY PLAN
EQUIPMENT BREAKDOWN 1
In case of machine breakdown, Medical Technologist/s who uses the machine daily must do the preventive maintenance like cleaning and calibration.
2
If the Medical Technologist/s failed to sort out the problem of the machine, he/she must call an authorized technician or service engineer.
3
Back‐up machine should be used while the machine is under repair.
4
For the tests and examinations without back‐up machines, tests must be sent out as soon as possible to laboratory that provides higher service capabilities.
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DIAGNOSTIC TEST PROCEDURES
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MICROSCOPY URINALYSIS
A. Physical Examination Takes note of the color and transparency (using combitix test strips).
B. Chemical Examination
1. Use fresh urine that has not been centrifuged. Thoroughly mix the urine sample. 2. Briefly (no longer than 1 second) dip test urine on the brim of the vessel. 3. After 60 seconds compare reaction color with the color scales on the label.
Colorations appearing only along the edges of the test patches, or developing after more than 2 minutes, do not have any diagnostic significance, the urine specimen should not stand for more than hours before testing. Report: ph, protein, glucose, specific gravity
The only chemical examination included in the routine analysis are for the determination of albumin and sugar. If we suspect by the color of the urine the presence of bile pigments or if the clinician so requests, we examine for the presence of bile by the use of the Smith’s method. To urine in a Kolmer tube, we add 3 – 5 drops of Gram’s iodine and a bluish‐green color ring at the line of contact indicates the presence of bile ‐ the origin of which is the total destruction of RBC. The principle involved in this test is oxidation of the bile acid and with the formation of a series of color derivatives like bilirubin, biliverdin, etc. We also do the foam test. Positive for bile are big bubbles which are yellow in color.
A. Albumin
Albumin is present in minute traces in the urine (75 mgm/hour output) so small in amount that it could not be detected by any laboratory method or procedures. Different laboratories uses different methods detecting the presence of albumin in the urine, but whatever test is performed, there is only one principle involved and that is coagulation by heat and precipitation by chemical agents.
In our laboratory, we use 10% acetic acid in “Heat and acetic acid test”. To a centrifuged urine, the upper third of which is heated over an open flame to a gentle boiling, then add 3 – 5 drops of 10% HAc, and using a dark background, allowing the light to enter within the urine and the background. Note for any cloudiness that is formed. Any cloudiness that formed upon heating and which disappears upon the addition of the acid is due to phosphates only. If it is really albumin, the cloudiness that formed upon heating will not disappear but will even be more marked.
DIAGNOSTIC TEST PROCEDURES
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There are many classes of albuminuria (presence of excess albumin in the urine but all of them falls under one of these three (3) classes:
1. Physiologic Albuminuria – where albumin is heavy, but which under the
microscope, there are no significant sediments and which may not be due to food rich in proteins taken or due to posture or exercise etc., and which is not permanent.
2. Accidental Albuminuria – where albumin is heavy because of the presence of albumnious sediments like pus, RBC, etc.
3. Pathological Albuminuria – where the clinician are most interested in and we are apt to see plenty of casts. The two most important protein found in urine in pathological conditions are serum albumin and serum globulin.
B. Sugar
There are various sugars found in the urine like lactose (usually found during lactation), fructose or levilose (fruit sugar), galactose, dextrose or glucose (kind of sugar found in the urine of diabetics). These sugar are so small in amount that they cannot be detected by laboratory procedures. There are several methods for the determination of sugars in the urine but one that we adopt is that one which is most common in laboratories in the Philippines is the Benedict’s test, a qualitative test for sugar.
The test is popular due to its simplicity of application, sensitiveness and freedom of error. This does not react with normal sugar of the urine but detects whatever is excess of this amount as low as 0.2%. The principles involves in mostly all test is reduction. When the whitish blue cupric hydroxide in suspension is heated, it is converted the soluble cupric hydroxide but if sugar is present, this is reduced to insoluble yellow or red cuprous oxide depending upon the concentration of the sugar present. The chemical composition of the Benedict’s qualitative reagent: 17.3 gms. ‐ Copper sulfate dissolved in around 60 cc. of water 173 gms. ‐ Sodium Citrate 100 gms. ‐ Sodium carbonate, if a hydrous
117 – 118 gms if monohydrated 200 grams if crystalline
These two chemicals are dissolved together with the aid of heating in around 500 cc. of distilled water. When all chemicals are dissolved, add the copper sulfate to the sodium citrate and carbonate and fill with distilled water up to 1,000 ml.
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PROCEDURE: To a 5 cc. of Benedict’s qualitative reagents placed in a Kolmer’s tube, add .5 cc of urine, mixed and placed in boiling water for 5 minutes. Let cool and observe for the color change. No change of color is negative. A green color is +; a ++ has a yellow color; a +++ assumes an orange color and a brick red is reported as ++++.
In our laboratory, we reduce the amount of the reagent to 1 cc. with a corresponding decrease in the quantity (0.1 cc.) of urine to be tested. This change in the amount does not make any difference in the end result because even if we reduce the amount of the reagent, we also reduce the quantity of the urine added.
C. Microscopic Examination:
Casts‐ identity type. Report number on slide or average. Lpf. WBC & RBC‐ Average range/hpf. Epithelial cells, crystals, amorphous urates, mucus threads‐ Report/lpf. Bacteria – report/ hpf in pluses.
MICROSCOPY PREGNANCY TEST
Pregnancy is a term used for a laboratory examination for the confirmation of early normal pregnancy, evaluation of abnormal pregnancy, and the study of trophoblastic disease. All pregnancy tests are designed to measure or detect human chorionic gonadotropin {HCG}, a hormone produce by viable placental tissue. IMPORTANCE OF PREGNANCY TEST: 1. To determine if a woman is pregnant or not, because some woman needs medications. 2. To determine if there has been complete or incomplete abortion. 3. To differentiate pregnancy from uncommon condition like hydatidiform mole and
chorioepithelioma. 4. To differentiate other pelvic diseases. 5. To differentiate pathologic condition of mole, like chorioepithelioma, teretoma,
choriocarcinoma of the ovary.
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PROCEDURE: 1. Instruct patient to collect 5ml of urine into a clean vials or container. 2. Make sure that the specimen submitted should be clean; otherwise it must be filtered or centrifuged. 3. Open the kit and using the enclosed dropper, put 3 drops of urine at
the circle ring. 4. Wait for 3 minutes, then read results. INTERPRETATION OF RESULTS: POSITIVE – two distinct line appears on both the T and C window. NEGATIVE– only one line appears on the C LINE.
MICROSCOPY SEMINAL ANALYSIS
Collection of Sample Patients should be asked to abstain for three (3) days before sample collection. The most satisfactory sample, is that colleted in the clinical laboratory. If this is impossible, patients it from extremes of temperature. It should be collected in wide mouth plastic or glass container but not in condoms which may contain spermatozites Analysis
1. LIQUEFACTION. Freshly ejaculated semen is a viscid, opaque, white coagulum. Incubate the sample at 37°C for 30 m ins. And examine for liquefaction of the semen. Normal semen should be liquefied completely.
2. VOLUME. Normally the volume of seminal fluid ranges from 1.5 to 5ml with a mean of 3.5 ml. Infertile males often have an increased volume of seminal fluid with a diminished sperm count.
3. pH. Normally the pH does not vary much and it is usually between 7.7 and 8.0 Values below 7.0 are usually associated with semen consisting primarily of prostatic secretion.
4. SPERM MOTILITY. To evaluate motility, place a drop of semen on a slide that has been prewarmed to 37°C. Examine under x 40 objective and determine the percentage of motile sperm. Normally more than 70% of spermatozoa show active motility within our hour of ejaculation.
5. SPERM COUNT. a. Pipette 0.02 ml of well mixed seminal fluid into 0.38ml of diluting fluid in a test
tube. b. Mix and charge a counting chamber. Allow to settle for two minutes.
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c. Count two of the large squares (2 sq mm) and multiply the figure obtained by 100,000 to obtain the number per ml. Normal values ranges from 60 to 150 million per ml. of seminal fluid. Value of less than s20 million per ml. are associated with infertility.
The Diluting Fluid in 1% Fomalin 1. Physical Examination
Color – Opaque fray or pearly to light yellow. Odor – a distinct odor. Mustly, spermatic, fishy, chlovox like Viscocity – freshly ejaculated specimen is highly viscid, of creamy gelatinous, absence of this characteristics is an indication of low count.
MICROSCOPY MALARIAL SMEAR In identification of species we use two kinds of smear:
1. Thick smear – used in searching for blood parasites 2. Thin smear – used for studying morphology of parasites.
It is best to examine blood which is take 10 – 12 hours after the chill to several hours before the chill.
Preparation of Staining of the Thick Smear: 1. Touch the surface of the slide of the crest of the large drop of the blood without
touching the skin. Move the slide in a narrow circle in the blood until the smear about the size of a dime is made.
2. Lay the slide flat to dry at room temperature and protect against bright sunlight, dust, and insects.
3. Do not fix. Place the slide on the staining bridge and gently cover with diluted Giemsa’s stain for 3 minutes or until the hemoglobin is dissolved from the erythrocytes making them transparent for examination.
4. The cytoplasm to the malarial organism stain blue and the chromatin is purplish red. Then gently tilt the slide and allow to stain to drain off. Cover again with diluted Giemsa’s stain taking care not to dislodge the drop of blood. Stain for 30 minutes.
5. Remove the stain by gently titling the slide. Wash the stain with neutral water so as not to remove the blood drops from the slide and allow to dry. Examine under oil immersion objective.
Identification of Species:
1. It is best to examine the blood taken during the period 10‐12 hours after the chill to several hours before the chills.
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2. Regular smears are made and stained longer than the regular staining with Giemsa. Thin smear are better for studying the morphology of the parasites.
Blood platelest lying on the erythrocytes must not be mistaken for malarial parasites. 3. Thick smears –
a, A relatively larger quantity of blood is placed in a smaller area in a slide and stained with Giemsa’s so that the hemoglobin is dissolved from the erythrocytes making it sufficiently transparent for examination with transmitted light. b. The organism stains the same as in thin films but do not appear in erythrocytes; only parasites, leukocytes and platelets are stained.
Procedure: 1. Fix blood smear with 95% absolute alcohol for 1 minute. 2. Decant alcohol. Don’t wash with water. 3. Stain Giemsa working standard solution for 7 minutes. 4. Wash with water, dry and examine.
Working solution (1:10 dil.)
- 1 cc. stock Giemsa - 9 cc. Buffer’s distilled water
MICROSCOPY FECALYSIS
A. Macroscopic or Physical Examination – Take note of: Form, consistency, color, odor, mucous, blood, parasites
B. Microscopic Examination – Report the following by count per low power field or high power field.
Epithelial cells mucus threads crystals Leukocytes tissue fragments Erythrocytes Bacteria
Parasite ova – report number/coverslip
FECALYSIS: NORMAL Form Consistency – Soft or semiformed Color – Light brown to dark brown Odor – Offensive but not excessively foul Mucous – very small amount Blood – negative Parasites – negative Bus cells – very insignificant amount
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Undigested foods – present (but those that are really and normally can not be digested)
Feces – are normally composed of water and solids, such as bacteria, intestinal concretions, food residues such as seeds vegetables skins, hairs, fibers, vegetable cells muscle fibers, fat droplets and other soluble substances. Importance of fecal examination:
a. Presence of a specific disease agent such as intestinal parasites. b. Indirect evidence of malfunction of some portion of the gastro‐intes‐ tinal
trac, the liver or pancreas. Collection of Specimen: Patient to undergo fecal examination should avoid taking barium, bismuth or eil for 5 days preceding the examination.
1. Pass out in bed pan or any sterled container and avoid admixture of urine, dirt, cotton fibers, tissue papers, gauze threads.
2. By means of a match stick or tooth pick or applicator stick or tongue depressor get about a pea‐size or marble‐size or thumb‐size or guava‐size.
3. The mid portion is the best, however, select also the bloody or mucoid portion. 4. In case of liquid stools, take about 10 cc. of 1/3 full of an eight to ten ounce bottle
container. 5. Container‐ it is preferable to have a clean, dry and steriled container of a wide mouth
with a screw cap or a paraffinized box of ice cream of a box of about 2‐8 ounces in size. 6. Examine immediately, if delayed note the fresh specimen’s color, odor and consistency.
Preservatives:
a. refrigerator b. 2% 5%, 10% formaline c. 40% alcohol d. Freezing in dry ice e. Buffered glycerol saline solution f. MIF preservative (Merthiolate‐Iodine) g. PVA fixative (Polyvinyl alcohol)
Procedures in preservation of stool specimen:
a. If the specimen is formed or soft and enough water and mix it thoroughly with applicator stick.
b. Strain of filter it through a 2 layered gauze of cheese cloth c. Leave the strained specimen for 30 mins. To 1 hour to allow settling of
sediments.
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d. Decant the supernatant liquid and replace it eith the preservative you would like to add.
e. If stool is watery or liquid, specimen is simply strained through 2 layered gauze or cheese cloth and do the other procedures as above.
Macroscopic Examinations of Physical Examination:
1. Amount and frequency Normally – 100 to 200 grams per day and 1 to 2 times a day 250 grams per day in case of moist and vegetable diet 1/3 to ½ of the dry weight is bacteria.
2. Form, Consistency and size Normally – soft or semiformed Abnormal – a. soft, mushy and watery stools are found in diarrhea or ofter the use
of cathartics. b. Excessively hard and scybalous stools are found in constipation c. Flattened or ribbon – like stools are found in spastic colitis, stricture, tumor, ulcer or carcinoma and obstruction of the lower portion of the colon.
3. Blood Normally – no blood is found in the stool Abnormal
A. Gross Blood Take note the character of the stool, if tarry, reddish or bright red, also note the distribution of the blood whether evenly mixed, partially mixed or only on the outside. 1. If stool is dark in color or tarry and blood is thoroughly mixed the origin of
the blood is usually from the upper gastro‐intestinal tract and even in the respiratory organs such as the nose and mouth.
2. If the stool consist of bright red blood and not thoroughly mixed the origin of blood is most likely from the lowed bowel and anal opening.
B. Occult Blood This is undetected by the naked eye nad can only be detected by chemical.
4. Parasites
Normally‐ there should be no parasites in stool.
Abnormally – some parasites can be easily seen like the adult ascaris and segments of tapeworms. Other adult’s parasites such as hookworms,
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Pinworms and trichinella can only be seen by sedimentation procedures And mixing with water and running through a fine sieve or gauze. A hand lens may be necessary to identify the tiniest ones. Ovum, cyst and trophozoites are been by the use of a microscope.
Artifacts Most Likely Mistaken for Parasites: a. Poorly masticates celery or greens for round worms. b. Cells from oranges for pinworms c. Fibers from banana for tapeworms and ova.
5. Pus Cells
Normally – a very insignificant number of pus cells is present. Abnormally – presence is indicate of ulcerative colitis, whereas mucus
Alone indicates mucus colitis. Generally present in ulcerative cases of the bowels due to syphilis, tuberculosis, bacillary dysentery or in large quantities after the rupture of an abcess.
6. Undigested Foods Normally – these are present but those that are really and normally can
Not be digested. These are however, of less importance. Most commonly seen ate seeds and fivers which are confused for concretions and parasites. Also curd, like masses are often mistaken for pus and concretions. Fats may be identified by their solubility in ether.
7. Concretions
Normally – is not seen in stool
MICROSCOPY GRAM STAINING
PROCEDURE:
1. Heat fixed smears to be stained. 2. Stain smear with CRYSTAL VIOLET for 1 minute. 3. Wash with tap water. 4. Mordant with GRAM’S IODINE for 1 minute. 5. Wash with tap water. 6. Decolorize with ACID ALCOHOL until no more pink comes off. 7. Wash with tap water. 8. Counterstain with SAFRANIN for 1 minute.
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9. Wash with tap water. 10. Blot slide dry. Examine under oil immersion. Note: Filter stain daily RESULTS: Gram (+) organism – PURPLE
Gram (‐) organism ‐ PINK
MICROSCOPY Occult Blood Determination (Benzidine Filter Paper Method (Modified)
REAGENTS: Filter Paper Reagent – A Reagent – B
Note: Keep tightly capped and cover immediately after use. PROCEDURE: 1. Smear a small particle of feces on a piece of filter paper with a wooden applicator stick.
2. Add 3 drops of Reagent A. 3. Add 3 drops of Reagent B. 4. Read within 1 minute.
RESULTS: POSITIVE – Any trace of BLUE on or at the edge of the smear indicates a positive test for occult blood. NEGATIVE – No detectable blue on or at the edge of the smear indicates a negative test for occult blood.
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MICROSCOPY CEREBROSPINAL FLUID EXAMINATION
A. Macroscopic or Physical Examination ‐ observation the following: color, turbidity, coagulation, reaction, specific gravity B. Chemical Examination Pandy’s Test for Albumin Reagents: Phenol crystals 10 gms. Distilled water 100 gms Procedure:
1. Place 1 cc of a saturated aqueous solution of phenol in small test tube. 2. Add 1 large drop of spinal fluid. 3. A bluish‐white cloud forming immediately around the drop indicateds an
abnormal amount of albumin. 4. Normal fluids may show a faint trace but this should be reported as negative.
CEREBROSPINAL FLUID
MAGROSCOPIC OR PHYSICAL EXAMINATION S 1. AMOUNT
a. The normal amount is roughly estimated to be about 1 cc. per pound or body weight. Also roughly estimated to be about 100 to 150 cc. everyday production. b. there is increased amount in acute and chronic congestion of the meninges due to increased transmudation of plasma through the capability of the chororoid plexus. c. There is also an increased amount in acute and dochronic infection due to the production of inflammatory exudatic and to increased permeability of the capillaries.
2. PRESSURE a. Normal pressure for the horizontal position varies between 70 and 200mm. of water (0.8 mm. of mercury) with the average of 100 to 150 mm. 3. Color a. Normally the fluid is as clear and colorless as distilled water.
b. Bright red due to fresh blood from a vessel punctured while inserting the needle; upon centrifugation the supermutant is clear. c. Dull red of brown (depending on the age of the lesion). In hemorrhagsa gue chronic hemorrhagic pachmeningitis. After 48 hours memolysis begins, so that a hemorrhage of
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at least this age is recognized by the yellow or red color of the supernatant fluids after contrifugation. d. Yellow (xanthochromic) may be to blood pigments resulting from disintegration of RBC within the subrachnoid space or to altered permeability of the lining membranes to pigments in the blood plasma which under normal condition are excluded. e. Greenish or grayish due to pus cells in severe inflammatory reactions.
4. TURBIDITY
a. In acute meningitis the fluid may exhibit varying degrees of cloudiness, from slight turbidity to the capacity of almost pure pus. b. In the less acute stage of epidemic meningitis, it is sometimes quite clear. c. It is usually clear in tuberculosis and syphilitic meningitis, tabes, and polimyclitis.
5. COAGULATION a. Normal spinal fluid does not coagulated b. Abnormal 1. The fluid clots when there is an increase in protein including fibrinogen 2. Numerous small coagula occur in pasesis
3. A “cobweb” or “pine tree” delicated coagulum is typical of tuberculosis meningitis; it forms on the surface fluids and extends down the middle of the tube. a) Twelve or more hours may be required for its formation b) The absence of pellicle does not exclude tuberculous meningitis. 4. Heavy coagulum and sediment occur in acute cuupurative meningitis. 5. Complete coagulation with xanthochromia without hemorrhage occurs in Froin’s syndrome (spinal subarachenid) block 6. Reaction The normal ph is 7.4 to 7.5 7. Specific Gravity The normal specific gravity is 1.003 to 1.008
CHEMICAL EXAMINATION
1. Proteins – Qualitative Test General Considerations
a. The protein of chief intrest is globulin b. The test for globulin is valueless when applied to fluid containing blood, owing to the
presence of seruminglobulins. c. If the fluid is cloudy, it should be centrifuged and the clear supernatant fluid used for
the test. A. None – Apelt Test for Globulin Reagents: Merck’s purified neutral ammonium sulfat. 85 gms. Distilled water……………………………100 cc.
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Boil and filtered as soon as it is cooled. PROCEDURE: a. Place equal amount of spinal fluid and saturated solution of ammonium sulfate in a
test tube and mix by inverting the tube. b. Allow the tube to stand for three minutes. c. Fluud that contains a normal amount of globulin will remain clear or become slightly
opalescent, if an excess of globulin is present a cloudy precipitate will form.
B. Ross – Jones Test a. Place L cc. of spinal fluid into a small test tube b. Add 1 cc. of ammonoun sulfate to the bottom of the tube(plug the pipet and
immerge to the bottom of the tube and release the ammonium sulfate, the plug it again and withdraw the pipet)
c. A clear out, thin, grayish‐white ring appears at the zone of contract for positive reaction. Under normal condition the ring will appear after 5 minutes.
d. Observe for 3 minutes, then mix the solution e. Interpretation:
- Ring in 3 minutes and no trace after mixing. - Ring in 3 minutes and faint opalescent after mixing. - Ring in 3 minutes and definite cloud after mixing. - Ring in 3 minutes and heavy cloud after mixing.
For Albumin Test
a. Shake the content of the tube used in the globulin test and filter b. Acidity with 1 drop of 10% acetic and boil c. A light cloudiness is normal d. Interpretations:
Negative‐ a slight cloudiness - definite cloudiness with fire precipitate - a flocculent precipitate in a slightly cloudy fluid - a heavy flocculent precipitate in a clear fluid.
C. Pandy’s Test for Albumin Reagent Phenol crystals‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐10 gms. Distilled water‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐100gms.
Procedure: a. Place 1 cc. of a saturated aquecous solution of phenol in a small test tube. b. Add 1 large drop of spinal fluid c. A bluish‐white cloud forming immediately around the drop indicates an
abnormal amount of albumin. d. Normal fluids may show a faint trac but this should be reported as negative.
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Total Proteins –Quantitative (Normal value is 30 mg. per 100 cc.) Principle: The protein is precipitated from the spinal fluid with acid tungstate, dissolved, and reprecipetated. The nitrogen is determined on an aliquiet portion after being put into solution with the aid of sodium hydroxide. General Considerations
a. Presences of blood give false high values. b. Presences of bacteria gives unreliable results c. Delay of analysis increases the value obtained unless fluid is kept sterile and tightly
corked.
Procedure of the test is similar to Blood Chemistry procedure. HEMATOLOGY ACID FAST STAINING PROCEDURE:
Heat fixed smears to be stained. Flood smear with CARBOL FUCHSIN and steam for 5 minutes. Wash gently with tap water. Decolorize with ACID ALCOHOL only until faint pink color remains. Wash with tap water. Counterstain with METHYLENE BLUE for 1 minute. Wash gently with tap water. Blot the slide dry. Examine under oil immersion.
RESULTS: ACID FAST BACILLI – RED OR DARK PINK NON‐ACID FAST ORGANISM ‐ BLUE
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HEMATOLOGY PLATELET COUNT
Indirect Method
1. Make a good blood smear from venous blood taken into EDTA, or from a freely flowing skin puncture. Dry in the air and stain with right’s hema quick stain.
2. Using an oil immersion objective, count the number of platelets per 1000 RBCs. 3. Perform an accurate red cell count. 4. Calculate as follows: If P is the number of platelets counted per 1000 RBCs, then
platelets
= P x RBCs per ul 1000
Alternatively, the formula can be simplified as follows: Platelets count x 109/L =P x RBC Normal values: 150,000‐350,000/mm Rees‐Ecker
1. Fill a red cell diluting pipette with freshly filtered Rees‐Ecker solution and expel it, leaving a film of the solution inside the pipette.
2. Draw capillary blood to the 0.5 mark on the rbc pipette. 3. Wipe excess blood and dilute to 101 mark with Rees‐Ecker diluting fluid. 4. Shake pipette for several minutes. Discharge a few drops, then charge both
chambers of the counting chamber. 5. Allow the thrombocytes to settle for 15 minutes. To prevent drying, place the
counting chamber on a damp filter paper inside a Petri dish. 6. Count the four big squares as in wbc. 7. Calculate as follows:
No. of cells counted x 2000 = platelet/ cu.mm Normal Value =150.000‐350,000/cu. mm
HEMATOLOGY COMPLETE BLOOD COUNT
A. WHITE BLOOD CELL COUNT
Equipment and reagents: 1. White blood cell diluting fipette 2. Hemacytometer 3. Hemometer with thick covership 4. Microscope 5. Cotton balls with alcohol
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Diluting fluid: Glacial Acetic Acid 1cc. 1% Crystal violent solution 1cc. Distilled water 100cc. Rules in counting Leukocytes or White Bloods Cells
1. Discard 2‐3 drops of diluted blood (sucked at exactly) 0.5 mark of the pipette and diluted up to 101 mark past the bulb) from the pipette to the hemacytometer, before charging shake the pipette for 2‐3 minutes, place the cover glass I its proper position over the ruled area of the hemacytometer.
2. The pipette is held practically horizontal while filling the counting chamber to keep to much fluid from running under the cover glass.
3. Allow one minutes for the leukocytes to settle, focus under low power. 4. If there is doubt as to whether the object is leukocytes have definite cell outline and
well‐defined nuclear structure. Platelet appears as very small refractile bodies with nuclei. Erythrocytes should not be present because the diluting fluid hemolyze them.
5. Count 4 corner group of 16 squares. . count first the upper left square, then upper right drop down to the lower right and last to the lower left.
6. Calculation: Cells counted x 20 (dilution x 10 (depth) No. of square mm. counted (4 sq. mm) = leukocyte/cu. mm. Or cells counted x 50 = leukocyte/cu/mm
B. HEMATOCRIT DETERMINATION 1. Fill capillary tubing with blood 2. Seal capillary tubing. 3. Centrifuge capillary tubing with blood for 3‐4 minutes 4. Read the volume of packed red blood cells cover the graduated plastic scale.
Read at the meniscus of the erythrocyte of the erythrocyte column. 5. The reading represents the volume of packed erythrocytes per 100 cc. of blood.
C. Hemoglobin Method: cyanmethemoglobin
Among the forms of hemoglobin well adapted to photometry, Cyanmethemoglobin has outstanding advantages.
a. All forms of hemoglobin likely to be formed in blood with exception of Sulfomethemoglobin, are quantitatively converted to cyanmethemoglobin upon the addition of a single reagent.
b. Solution of cyanmethemoglobin are the most stable of the various hemoglobin pigment.
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1. Drabkins
Procedure: 1. Measure 5 ml of drabkins solution into a test tube. 2. with a Sahli pipette, measure 20 cumm blood and transfer into the test tube
containing Dabkins solution. 3. Mix , let Stand for 10 minutes to allow formation of cyanmethemoglobin. 4. Using Stat Fax machine Filter at 550 read to obtain result.
D. Differential Count Making the Blood Smear (Two Slide Method) Procedure:
1. Prepare a small drop of blood in the middle the first at an of one of the slides. 2. Hold the second slide (spreader) above the first at an angle of 30‐45 degrees. 3. Draw the spreader toward the drop of blood and contract the blood ‐ ‐ ‐ the blood
should fan of spread out to the edges of the spreader. If it does not fan, wiggle the spreader a little to make it do so. (Don’t let the blood get ahead of the spreader because it may cut or distort the cells)/
4. Push the spreader smoothly and rapidly over the entire length of the slide at constant angle (30‐45) degrees and keep the edge of the spreader pressed firmly against the slide.
5. Air dry before staining.
HEMATOLOGY STAINING (Using Hema‐Quick Stain Set)
E. Staining Reagents:
Hema‐Quick solution 1 – 250mL Hema‐Quick solution 2 – 250mL Hema‐Quick solution 3 – 250mL
Hema‐Quick solution 4 – 250mL Hema‐Quick solution 5 – 250mL
NOTE: Hema‐Quick Stain 1 – 250mL (For Rapid Staining of blood Smoars) These solutions should be placed in coplin jars or other dip staining devices that
can be covered to prevent evaporation.
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PROCEDURE:
1. Prepare slides in the same way you are preparing slides for differential cound.
2. Air dry smear before staining. 3. Dip air‐dried smear five (5) times for about one (1) second each dip into
Solution 1, Solution 2, and Solution 3. 4. Rinse the slide into Solution 4. 5. Allow to dry. 6. Examine under oil immersion lens.
RESULTS: ERYTHROCYTES ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ pinkish color PLATELETS ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ purple granules POLYMORPHONUCLEAR NEUTROPHILS NUCLEUS ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ dark blue CYTOPLASM‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ pale pink GRANULES ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐reddish purple HEMATOLOGY RBC Count: Men – 4,500,000/cu. mm. Women – 4,000,000 – 5,000,000/cu. mm Normal women in late pregnancy – 3,000,000 –
5,000,000/cu. mm. WBC Count: Male/Female – 5,000 – 10,000/cu.mm. Heloglobin: Men – 14 ‐18 gm/100 cc Women – 12 – 16 gm/100 cc Children – 14 – 26 gm/100 cc Hematocrit: Men – 40 – 54 vol.%Ave. 47 vol.% Women – 37 – 47 vol.% Ave. 47.% Normal Women in late pregnancy – 23 – 24 vol.% Coagulation Time: Slide method – 2 – 4 minute
Platelet Count: 250,000 – 300,00/cu.mm.
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HEMATOLOGY COAGULATION TIME Method – Slide Method Procedure:
1. Make a deep puncture in the ear lobe or the ring finger 2. The size of the wound should be such that the blot of diameters. Note the time of
the first drop blood that appears. 3. Remove the drops of blood with the filter paper at 30 seconds intervals being careful
not to touch the skin. The end point is reached when no more blood appears. 4. If moderately prolonged the 20th drop will be ½ of the size of the first and if
markedly prolonged, the 20th drop will be as large as the first HEMATOLOGY BLEEDING TIME (Duke’s Method) PROCEDURE:
1. Make a deep puncture in the ear lobe or the ring finger. 2. The size of the wound should be such as in blot of the blood after 30 seconds
intervals is 1‐2 mm. in diameter. Note the time of the first drop of blood that appears.
3. Remove the drops of the blood with the filter paper at 30 seconds intervals being careful not to touch the skin. The end point is reached when no more blood appears.
4. If moderately prolonged the 20th drop will be ½ of the size of the first and if markedly prolonged, the 20th drop will be as large as the first.
HEMATOLOGY RETICULOCYTE COUNT RETICULOCYTES are proerythrocytes or pornormocytes or skin cell are which are immature erythrocytes which show reticulum when stained by some supravital method. This vital stain precipitates the basophilic substances of the reticulocytes. USES OF RETICULOCYTE COUNT:
1. As diagnosis for lead poisoning, hemolytic icterus. 2. To determine responses of pernicious anemia to Vit. B12 3. To diagnose acute hemorrhage.
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COMPOSITION OF SOLUTION A AND B FOR RETICULOCYTE COUNT:
A – 1% of brilliant cresyl blue B ‐ 1% K oxalate Reticulocytes count by sewered – sabin methylene blue.
NORMAL VALUES:
0.5 – 1.5 %
METHODS OF RETICULOCYTES COUNT: 1. Method of choice using Methelyne blue normal solution 2. Method of cook, mayer and tureen’s method. 3. Rapid method of schilling. 4. Stiff modification of Klemperee method. 5. Sabin method.
TECHNIQUE OF COOK, MAYER AND TUREEN METHOD:
1. Place five drops of 1% solution of brilliant creysl blue in saline in a watch glass or add 1 drop of 1% solution of Potassium oxalate in saline.
2. Using Sahli pipette, draw up some blood and equal amount of the mixed stin. To avoid precipitate, do not use excessive stain.
3. Mix thoroughly by alternately blowing out into the pipette; allow standing 5 or 6 minutes. Cover with a Petri dish to prevent evaporation.
4. Place a drop of mixture of blood and stain upon the ends of a glass slide and spread in the manner of making ordinary blood film.
5. Dry quickly to prevent distortion of the cells. This slide maybe examined immediately or counter stained with either Wright or Giemsa’s stain. If Giemsa is used fixed first for 3 minutes in Methyl alcohol preparatory to staining.
6. Place a piece of paper, the size of the eyepiece with an opening of 5 mm. square cut. This reduce the size of the field.
7. Count 1000 erythrocytes noting down the number of filaments, skeins or wreaths. 8. Calculation =
No. of reticulated cells x 100 ‐ % reticulocytes or No. of reticulocytes 1000
9. Normal reticulocytes count is 0.5 – 1.5 % 10. Interpretation:
Increase – reticulocytosis is a sign of early regeneration or erythrocytes by the bone marrow. Count of less than 0.5% indicates an abnormally alow rate of production or erythrocytes by the bone marrow
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HEMATOLOGY PROTHROMBIN TIME TEST (PT – DETERMINATION)
PRINCIPLE: The one stage Prothrombin Time measures the clotting time of test plasma after the addition o Thromboplastin reagent containing Calcium chloride. The reagent supplies a source of “tissue trhromboplastin”, activing Factor VII, and is therefore sensitive to all Stage II and III Factors. Deficiencies of Stage 1 Factors (VII, IX, XI and XII) are not detected by test. PREPARATION A. Anticoagulant. Use buffered sodium citrate 3.2% B. Plasma Collection
1. Obtain venous blood by clean venipuncture 2. Use only citrate plasma for test analysis runs. 3. Mix 9 parts venous blood with 1 part 3.2% (0.105M) sodium citrate. 4. Centrifuge the mixture of 1500g for approx. 10 minutes. 5. Remove plasma from the tube within 60 min. using a plastic pipette
and store in a plastic tube. 6. Test plasma sample within 4 hr, otherwise store frozen and thaw
just prior to use.
C. Reagent Reconstitution Reconstitute with high purity water at the volume stated on the vial label. Let stand at room temperature with occasional swirling until solution is complete. Stable for 7 days after reconstitution when stored at 2‐80C, avoid prolonged heating.
D. Coatron M1 Preparation
1. Turn on instrument and wait until the ready led is lightning. 2. Turn on printer if connected 3. Select “PT” as active test 4. Check calibration 5. Allow reagent to prewar at least 5 minutes
PROCEDURE ON COATRON M1
1. Pipette 25 ul plasma into cuvette 2. Prewarm plasma for 1 min 3. Transfer cuvette to measuring position 4. Activate optic (press key “Optic”) 5. Add 50 u; prewarmed Thromboplastin and simultaneously start the optic, (press
key “Opitc” again) 6. The result will read maximal 300 secs. If no clot is detected, the display will read
“+++.+s” 7. The result is displayed in seconds and INR.
DIAGNOSTIC TEST PROCEDURES
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ASSAY CALIBRATION For INR‐calibration of PT two parameters are required. The normal value (determine PT normal value with Calibrator normal, ‐ expected range ois between 11 to 14 s) The ISI value (read ISI value on the label of the reagent vial) Enter both values into the Coatron M1. QUALITY CONTROL Control plasma should be tested in conjunction with patient samples. It is recommended that at least one Normal and one Abnormal be run at least each shift and a minimum of once per 20 patient samples. A Control Range should be established by the laboratory to determines the allowable variation in a day to day performance of each Control Plasma.
EXPECTED RESULTS OF CONTROL Control Normal 0.8 – 1.3 INR Control A1 2.0 – 3.5 INR Control A2 5.0 – 8.0 INR
BLOOD CHEMISTRY PTT DETERMINATION The APTT test measures the clotting time of test plasma after the addition of APTT reagent, then allowing an “activation time”, followed by the addition of calcium chloride. Deficiencies of approximately 40% and lower of Factors VIII, IX and XII will result in a prolonged APTT. Heparin, in the presence of adequate amounts of AT‐III will also result in a prolonged APTT. REAGENT APTT Reagent Calcium Chloride PREPARATION
A. Anticoagulant. Use buffered sodium citrate, 3.2%. B. PLASMA COLLECTION
3. Obtain venous blood by clean venipuncture. 4. Use only citrate plasma for test analysis runs. 5. Mix 9 parts venous vlood with 2 part 3.2% (0.105M) sodium citrate 6. Centrifuge the mixture at 1500g for approx. 10 minutes. 7. Remove plasma from the tube within 60 min. using a plastic
npipette and store in a plastic tube.
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8. Test plasma sample within 4 hr, otherwise frozen and thaw just prior to use.
C. Reagent Reconstitution Bring to room temperature prior to use. Mix well by swirling or inversion and maintain a stir bar in reagent container during use to avoid the particle activator from settling out. Avoid prolonged heating.
D. Coatron M1 Preparation
1. Turn on instrument and wait until the ready LED is lightning. 2. Turn on printer if connected 3. Select “PTT” as active test 4. Allow CaCl2 to prewar at least 5 minutes.
ASSAY CALIBRATION PPT results should be normalized against a normal value, which is obtained from a PTT of Calibrator Normal. – expected range: see box insert of Calibrator. Enter the normal value into the Coatron M1. The PTT is then displayed in seconds and normalized into Ratio. PROCEDURE ON COATRON M1
1. Pipette 25 ul plasma into cuvette. 2. Add 25 ul APTT to plasma 3. Incubate exactly for 5 minutes 4. Transfer cuvette to measuring position 5. Activate optic (press key “Optic” 6. Add 25 ul prewarmed Calcium Chloride and simultaneously start the topic. (press key
“Optic” again) 7. The instrument will read maximal 300 seconds. If no clot is detected, the display will
read “===.=s” 8. The result is displayed in seconds and Ratio 9.
QUALITY CONTROL Control plasma should be tested in conjunction with patient samples. It is recommended that at least one Normal and one Abnormal be run at least each shift and a minimum of once per 20 patient samples. A Control Range should be established by the laboratory to determine the allowable variation in day to day performance of each Control Plasma.
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EXPECTED RESULTS OF CONTROLS Control Normal 0.8 – 1.2 Ratio Control A1 1.5 – 2.0 Ratio Control A2 2.0 – 3.0 Ratio BLOOD CHEMISTRY GLYCOHEMOGLOBIN
SPECIMEN COLLECTION AND PREPARATION:
Special preparation of the patient is unnecessary. Fasting specimens are not required. No special additives or preservatives other than the anticoagulants are required. Collect venous blood with EDTA using aseptic technique. Glycohemoglobin in whole blood collected with EDTA is stable for one week at 2 – 8 C. PROCEDURE: A. HEMOLYSATE PREPARATION:
1. Dispense 500 ul Lysing Reagent into tubes labeled: Standard, Control, Sample 2. Place 100 ul of the well‐mixed blood sample, standard or control into the appropriately labelled tube. Mix well. 3. Allow to stand for 5 minutes. Note: Plastic or glass tubes of appropriate size are acceptable.
B.GLYCOHEMOGLOBIN PREPARATION:
1. Dispense 3.0 ml of glycohemoglobin cation‐exchange resin into glass tube labeled Standard, Control, Sample. NOTE: Before using, mix the resin by inverting at least 10 times.Swirl the bottle after Addition to each 5 tubes. 2. Add 100 ul of the hemolysate from step A. 3. Position the filter separators in the tubes so that the rubber sleeve is approximately 1cm above the liquid level. 4. Place the tubes on the rocker or rotator and mix continuously for 5 minutes. 5. Remove the tubes on the rocker or rotator. 6. Push the filter separator into the tubes until the resin is firmly packed. 7. The supernatant may be poured into another tube or directly into a cuvette for absorbance measurement. 8. Adjust the instrument to zero absorbance at 415 nm with deionized water as the blank. Wavelength range 390‐420 nm.
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EXPECTED VALUES: 6.6 – 8.6%
BLOOD CHEMISTRY ENZYMATIC GLUCOSE (Trinder/GOD‐POD)
INTENDED USE For in vitro diagnostic use in the quantitative determination of glucose in serum or plasma REAGENTS:
GLUCOSE BUFFER GLUCOSE ENZYME REAGENT GLUCOSE STANDARD (100 MG/D1)
SPECIMEN Plasma or serum should be separated from the cells as soon as possible after collection. Samples should be assayed promptly. Glycolysis in serum samples can cause a glucose loss of about 5‐10mg/d1/hr at room temperature (3). MANUAL PROCEDURE
All reagents must attain room temperature (20‐25oC) prior to use. Place 2.5 ml of Glucose buffer into test vials labeled: Unknown, control, standard, blank Add 0.020ml (20ul) of sample to the corresponding vial. Add 0.100ml (100ul) of glucose enzyme reagent to all vials, mix by gentle swirling and return to the 37oC heating bath for exactly 10 minutes. (Alternative: 25 minutes at room temperature 20‐25oC). Set the wavelength of the photometer at 510 nm and zero the photometer with the BLANK. Read the remaining vials, record the absorbance and proceed to Calculation with Example. Note: For a direct read‐out instrument, set read‐out to concentration of standard (100mg/d1). Read the unknown concentration directly. ENDPOINT STABILITY The final colored reaction product should be measured within 60 minutes. Avoid direct sunlight. CALCULATION WITH EXAMPLE Where A=absorbance, U =UNKNOWN, S = STANDARD, C= concentration: PROCEDURE LIMITATIONS: Expected values (6) Adult fasting plasma or serum: 70‐105 mg/d1
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PROCEDURE NOTES For glucose levels exceeding 500 mg/d1, re‐run the procedure on a 1:10 dilution of sample with 0.85% saline and multiply the result by 10. For moderately icteric or lipemic sample, add 0.20 ml (20 ul) of sample to 2.6 ml of 0.85% saline, mix and measure absorbance at 510 nm versus 0.85% saline BLANK. Subtract this absorbance value from the absorbance value obtained initially in the above Procedure, and then calculate corrected results. QUALITY CONTROL Quality control sera should be used routinely to monitor test precision (11). Refer to the manufacturer’s product insert for analyte stability and acceptable limits. Sterling Normal Control (Cat. #1003‐N) and Sterling Abnormal Control (Cat. #1003‐A) are recommended for this purpose.
BLOOD CHEMISTRY ENZYMATIC URIC ACID (Modified Trinder)
INTENDED USE FOR IN VITRO DIAGNOSTIC USE in the quantitative determination of uric acid in serum or plasma. REAGENTS: The following reagents should be stored under refrigeration (2 ‐8oC) and may be used until the expiration date indicated on the bottles.
URIC ACID BUFFER URIC ACID ENZYME REAGENT URIC ACID STANDARD (10mg/d1)
SPECIMEN Use unhemolyzed serum or plasma. Recommended anticoagulants are EDTA or herapin.
0Uric acid serum or plasma is reportedly (2) stable for 3 days at 2‐8oC and up to 6 months when frozen (‐20oC). Serum uric acid is destroyed when serum is allowed to remain in contract with red blood cells and when serum is contaminated with bacteria (2).
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MANUAL PROCEDURE
Transfer 2.5 ml of URIC ACID BUFFER to test vials labeled: UNKNOWN (S), STANDARD, CONTROL, BLANK. Add 50 microliters (ul) of sample to its respective vial. Add 100 microliters of URIC ACID ENZYME REAGENT to all vials, mix by gentle swirling, and allow to stand at room temperature (<30oC) for 10 minutes. Zero photometer at 520+5 nm using BLANK. Measure absorbance of all vials within 15 minutes. Note: For a direct read‐out instrument, set read‐out to concentration of Standard. Read the Unknown concentration directly. CALCULATION WITH EXAMPLE:
EXPECTED VALUES (6)
Children ………………………..2.0‐5.5 mg/d1 Adult Male……………………...3.5‐7.2 mg/d1 Adult Female……………………2.6‐6.0 mg/d1
PROCEDURE LIMITATIONS:
Elevated bilirubin (>9.94 mg/d1) and ascorbic acid (>190 umol/L in serum) can result in false uric acid values (4). The following substances reportedly (4) interfere in very high clinical doses: Methyldopa, L‐dopa, 3, 4‐dihydroxyphenylacetic acid, gentistic acid. PROCEDURE NOTES
Uric acid exceeds linearity: Prepare a 1.1 dilution of the sample with Reagent Grade Water and repeat test; multiply result by 2. Extremely lipemic sample: Add 50 microliter of sample to 2.6 ml of Reagent Grade Water and measure absorbance from at 520 nm versus water in the same size cuvet as used in above PROCEDURE; subtract the absorbance from the original test absorbance and recalculate:
[(A (U)‐A (SB))/A(S)] x C (CS) =C (U) Where SB= Sample Blank SI unit conversion: [(mg/d1)/16.9] =mmol/L
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QUALITY CONTROL Good laboratory practice requires the use of normal and abnormal control sera at least once daily to monitor test precision and accuracy. We recommend Sterling Normal Control (Cat. No.1003‐N) and Sterling Abnormal Control (Cat. No.1003‐A) for this purpose. BLOOD CHEMISTRY CREATININE (Modified Heinegard‐Tiderstrom) INTENDED USE: FOR IN VITRO DIAGNOSTIC USE in the quantitative colorimetric endpoint determination of creatinine in serum and urine. REAGENTS: The following reagents can be used until the expiration date indicated on the individual bottles and should be stored at room temperature (30oC):
CREATININE BUFFER: PICRIC ACID CREATININE CLEARING SOLUTION CREATININE STANDARD
SPECIMEN
SERUM Use unhemolyzed serum. Stable if refrigerated (2‐8oC) for 24 hours. Freeze for longer storage.
URINE Collect 24hr urine in container with 15 gm of boric acid. Stable for up to 4 days if refrigerated (2‐8oC). Freeze for longer storage.
ENDPOINT PROCEDURE
Transfer 2.0 ml of Creatinine Buffer to vials labeled: UNKNOWN(S), STANDARD, CONTROL and BLANK.
Add 1.0 ml of Picric Acid Reagent to each vial and mix Add 200 microliters of sample to its respective vial and mix. (Add Reagent Grade Water to Blank).
Note: if assaying urine, use a 1:100 dilution of urine with Reagent Grade Water.
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Place all vials in 37oC heating bath for 15 minutes Zero the photometer at 520+5 nm using the BLANK. Measure absorbance of samples; these are the A1 readings. Add 2 drops of Creatinine Clearing Solution to each vial, mix and let stand for 5 minutes at room temperature. Measure absorbance as before; these are the Ao readings and should be made within 30 minutes. CALCULATION WITH EXAMPLES SERUM Where A = absorbance, U =UNKNOWN, S =STANDARD, C = concentration [U (A1‐Ao)/S (A1)] C(S) = C (U) (mg/d1) (mg/d1) EXAMPLE: U (A1) = 0.12, U (Ao) =0.05, S (A1) = 0.25, C (S) =5.0 mg/d1, then: [(0.12‐0.05)/0.25]x 5.0 mg/d1 =1.4 mg/d1 BLOOD CHEMISTRY UREA NITROGEN (BUN) (Berthelot/Colorimetric) INTENDED USE FOR IN VITRO DIAGNOSTIC USE in the quantitative colorimetric determination of urea nitrogen in serum REAGENTS The following reagents should be stored at 2‐8oC and can be used until the expiration date indicated on the individual bottle:
UREA N‐ZYME REAGENT UREA N COLOR REAGENT UREA N BASE REAGENT UREA N STANDARD(25 mg/d1)
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SPECIMEN Serum is recommended for the assay. Plasma may also be used, provided that anticoagulant use contains neither ammonium nor fluoride salts. Sodium, potassium, or lithium salts of herapin, EDTA, or oxalate are satisfactory anticoagulants. Urea in serum is stable for up to 24 hours at room temperature, for least several days at 4‐6oC, and for at least 2‐3 months when frozen. PROCEDURE
Transfer 0.5 ml of UREA N COLOR RGT to vials labeled: UNKOWN, CONTROL, STANDARD, BLANK.
Add 0.010 ml (10 ul) of sample to its corresponding vial. Add 0.5 ml of UREA N‐ZYME RGT to all vials, mix gently, and incubate at 37oC for 5
minutes*. Add 2.0 ml of UREA N BASE RGT, mix and incubate at 37oC for 5 minutes*. Set the wavelength of the photometer at 630 nm and zero the photometer with the
BLANK. Read and record the absorbances of all vials and proceed to Calculation with Example below. Note: For a direct read‐out instrument, set read out to concentration of Standard (25 mg/d1). Read the Unknown concentration directly. *Alternative: React for 10 minutes at room temperature 2‐26oC CALCULATION WITH EXAMPLE Where A = absorbance, U = UNKNOWN, S = STANDARD, C =concentration: A (U) x C (S) mg/d1 = C (U) mg/d1 A (S) Example: A (U) = 0.31, A (S) = 0.48, C (S) = 25 mg/d1 then: x 25 mg/d1 = 16 mg/d1 0.48 EXPECTED VALUES Healthy Ambulatory Adults ……….. 7‐18 mg/d1
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PROCEDURE NOTES If a sample exceeds the linearity of the test, make a five‐fold dilution of sample with ammonia‐free Reagent Grade Water (Cat. # 1075‐0) and re‐run assay; multiply result by 5. To extend linearity of test to 80 mg/d1 without dilution of sample, double reagent volume to 1.0 ml Urea N Color Rgt., 1.0 ml Urea N‐Zyme, 4 ml Urea N Base Reagent and retain the same sample size of 10 ul. QUALITY CONTROL Quality control sera should be used routinely to monitor test precision (7). Refer to the manufacturer’s package insert for analyte stability and acceptable limits. Sterling Normal Control (Cat. # 1003‐N) and Sterling Abnormal Control (Cat. # 1003‐A) are recommended for this purpose. BLOOD CHEMISTRY ENZYMATIC GLUCOSE (Trinder/GOD‐POD) Collect whole bloody by venipuncture and allow to clot. Contrifuge and remove serum as soon as possible. Blood should be collected after 12‐16 hours fasting to minimize turbidity; however, the effect of a meal on the cholesterol level reportedly (8) increases the level less than 3%. Cholesterol reportedly (9) decreases during ovulation, increases during sever emotional stress, varies in some individuals on a day –to‐day basis, and exhibits a seasonal variation in healthy young men (9). MANUAL PROCEDURE All reagents must attain room temperature (20‐25oC) prior to use. Transfer 2.5 ml of cholesterol Buffer to vials labeled: UNKNOWN‐ (S), STANDARD, CONTROL, BLANK. Add 20 ul (0.020ml) of sample to its respective vial. Add 0.1 ml (100 ul) of Chloresterol Enzyme Reagent to all vials, mix and incubate at 37o heating bath for 10 minutes.
Zero photometer at 510 nm with the BLANK vial. Read and record the absorbance of all vials. Note: For a direct read‐out instrument, set read‐out to concentration of Standard (200 mg/d1). Read the Unknown concentration directly. Use the absorbance readings of the Cholesterol STANDARD and UNKNOWN (S) to calculate the total cholesterol values as follows: A (U) x C (S) mg/d1 = C (U) mg/d1 A (S)
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EXPECTED VALUES AGE (YRS) MALES (mg/d1) FEMALES (mg/d1) 5‐19 125‐191 131‐208 20‐34 118‐258 121‐227 ` 35‐49 147‐275 139‐268 50‐64 156‐287 163‐300 65‐70+ 166‐265 167‐280 ‘DESIRED’ RANGE FOR ADULTS (10) 140‐250 mg/d1 PROCEDURE NOTES If the total cholesterol value exceeds 600 mg/d1 or the linear capability of the photometer, dilute the sample 1:1 with distilled water and re‐run the assay; multiply the result by 2. If the sample is extremely lipemic, prepare a sample blank by adding 0.020 ml (20 ul) of sample to 2.5 ml Cholesterol Buffer and add 0.1 ml of distilled water. Mix and measure the absorbance against Cholesterol Buffer. Subtract the value obtained from the value derived in step # 4 of the above procedure; this will yield a corrected absorbance value. QUALITY CONTROL Good Laboratory practice requires the use of normal and abnormal control sera at least once daily to monitor test precision and accuracy. We recommend Sterling Normal Control (Cat. # 1003‐N) and Sterling Abnormal Control (Cat. # 1003‐A) for this purpose. BLOOD CHEMISTRY TRIGLYCERIDES(Colometric) INTENDED USE FOR IN VITRO DIAGNOSTIC USE in the quantitative colormetri determination of serum triglycerides. REAGENTS
TRIG‐GPO BUFFER TRIG‐GPO ENZYME REAGENT TRIGLYCERIDE STANDARD
SPECIMEN
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Collect whole blood from fasting patients, allow to clot, centrifuge and revome serum with 2 hours of drawing. Collection tubes must not contain glycerol lubricant. MANUAL PROCEDURE All reagents must attain room temperature (20‐25 oC) prior to use. Transfer 1.0 ml of WORKING TRIG‐GPO to vails labeled: UNKNOWN, CONTROL, STANDARD, REAGENT BLANK. Add 0.010 ml (10 ul) of sample to its respective vial, mix by gentle swirling and place in 37oC heating bath for 10 minutes. Remove vials from heating bath and add 1.5 ml of Reagent Grade Water to all vails…… mix by gentle swirling. Note: The addition of 1.5 ml of Reagent Grade Water is necessary only if your photometer requires a final volume in excess of 1.0 ml; otherwise, you may measure the final color directly. Zero the photometer with the REAGENT BLANK at 515+5 nm. Record absorbance of all vials and proceed to Calculation With Example below. Note: For a direct read‐out instrument, set read‐out to concentration of Standard (250 mg/d1). Read the Unknown concentration directly. PROCEDURE LIMITATIONS: Grossly icteric samples (>10 mg/d1 bilirubin) should not be used. EXPECTED VALUES Adults: 10‐190 mg/d1 PROCEDURE NOTES
For grossly icteric or lipemic samples, prepare a SAMPLE BLANK by adding 0.01. ml of sample to 2.5 ml of 0.85% saline and measure its absorbance versus 0.85% saline at 515 nm. Subtract this absorbance from the TES T absorbance obtained in the PROCEDURE. For laboratories using the SI system: Mg/d1 x 0.0113 = mmol/L (Expressing triglycerides as triolein) QUALITY CONTROL Quality control sera should be used routinely to monitor test precision (16). Refer to the manufacturer’s package insert for analyte stability and acceptable limits. Sterling Normal
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Control (Cat. No. 1003‐N) and Sterling Abnormal Control (Cat. No. 1003‐A) are recommended for this purpose. BLOOD CHEMISTRY HDL CHOLESTEROL (PEG‐6000 method) INTENDED USE FOR IN VITRO DIAGNOSTIC USE in the quantitative determination of high density lipoprotein cholesterol (HDL‐C) in serum. REAGENTS The following reagents should be stored at room temperature (<3oC) and can be used until the expiration date indicted on the individual bottle: HDL PEG REAGENT HDL CHOLESTEROL STANDARD SPECIMEN Collect whole blood from a fasting patient by venipuncture and allow to clot. Centrifuge and remove serum. HDL cholesterol is reportedly stable for up to 1 week at 4oC (5) or ‐20oC (8). Hemolyzed specimen should not be used for this assay. PRECIPITATION STEP:
Transfer 200 microliters of the HDL PEG REAGENT to a micro‐centrifuge tube labeled: UNKNOWN (S), CONTROL, etc. Add 200 microliters of sample to its respective microcentrifuge tube, cap and mix vigorously. Using a 13 x 100 mm test tube as a carrier, centrifuge at 1000‐2000XG at least 10 minutes Proceed with Cholesterol assay. CHOLESTEROL ASSAY All reagents must attain room temperature (20‐25oC) prior to use. Add 2.5 ml of Cholesterol Buffer to vials labeled: UNKNOWN (S), STANDARD, CONTROL, BLANK. Add 100 ul of the supernate (from Precipitation Step) to its respective vial. Add 100 ul of HDL Cholesterol Standard to the STANDARD vial. Mix all vials. Add 100 ul of Cholesterol Enzyme Reagent to all vials, mix and return to the 37oC heating bath for 10 minutes. Zero photometer at 510 nm with the BLANK vial. Read and record the absorbance of all vials. Note: For a direct read‐out instrument, set read‐out to 100 mg/d1 (corrected for the dilution factor) and read the UNKNOWN concentration directly.
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EXPECTED VALUES
HDL CHOLESTEROL (mg/d1) Male Female Cord Blood 5‐50 5‐50 0‐14 yr 30‐65 30‐65 5‐10yr 30‐65 30‐65 20‐29yr 30‐70 30‐70 30‐39yr 30‐70 30‐80 40+ yr 30‐70 30‐85 Values for blanks are approximately 10 mg/d1 higher than the means and ranges given above. PROCEDURE NOTES Centrifugation should a clear supernatant. Since a cloudy supernatant will yield falsely elevated values, the sample should be centrifuged again to give a clear supernate. Dilution of a lipemic specimen with saline is not recommended owing to reportedly large dilution error (10). If a dilution must be performed, a 5% w/v solution of Bovine albumin in 100 mmol/L acerate buffer at pH 7.5+0.5, is recommended as the diluent. LDL Cholesterol Calculation LDL Cholesterol = Total Cholesterol‐HDL Cholesterol ‐* VLDL Chol. * VLDL Cholesterol = (Triglyceride) 4.6 QUALITY CONTROL Quality control sera should be used routinely to monitor test precision (7). Refer to the manufacturer’s package insert for analyte stability and acceptable limits. Sterling Normal Control (Cat. # 1003‐N) and sterling Abnormal Control (Cat.# 1002‐A) are recommended. URINE Where A = absorbance, U=UNKNOWN, S = STANDARD, C =concentration, 0.01 = factor for urine dilution, V =volume of urine for 24 hours (liters): [U (A1‐Ao)/ S (A1)] x C (S) x 0.01 x 100 V = C (U) EXAMPLE: U (A1) = 0.09, U (Ao) =0.02, S (A1) = 0.25, C (S) = 5.0 mg/d1, V =1700 ml/ 24 hours =1.7 L/24 hrs, then: [(0.09‐0.02)/0.25] x 5.0 mg/d1 x 0.01 x 100 x 1.7 L/ 24 Hrs = 2.38 Gm/ 24 Hrs
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CREATININE CLEARANCE [Urine Creatinine (mg/d1) x Urine Vol (ml/ min)]/ Serum Creatinine (mg/d1) = Creatinine Clearance (ml/min) Using above calculations and converting 1700 ml urine/ 24 hrs to 1.18 ml/min, then: [(140 mg/d1 x 1.18 ml/min) /1.4 mg/d1)] = 118 ml/min EXPECTED VALUES (6) MALES FEMALES SERUM (mg/d1) 0.7‐1.3 0.6‐1.2 URINE (Gm/ 24hrs) 0.8‐2.0 0.6‐1.8 CREAT. CLEAR (ml/min) 97.137 88.128 PROCEDURE NOTES The Ao absorbance reading of the STANDARD should be 0.00 since the addition of acid is designed to lower the pH and destroy all of the alkaline creatinine picrate complex. If the creatinine value exceeds 15.0 mg/d1, repeat the assay on 1:1 dilution; multiply result by 2. If turbidity occurs in test vials (step # 6 in Endpoint Procedure) after the addition of ‐.1 ml of Creatinine Solution, we recommend either of the following options: Centrifuge vials at high speed (2000‐3000 RPM) and read absorbance over the small ‘protein button’ in the bottom of vial. Repeat test using 0.05 ml (1 drop) of Creatinine Clearing Solution instead of the specified 0.1 ml. QUALITY CONTROL Good laboratory practice requires the use of normal and abnormal control sera at least once daily to monitor test precision and accuracy. We recommend Sterling Normal Control (Cat. No. 1003‐N) and Sterling Abnormal Control (Cat. No.1003‐A) for this purpose.
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BLOOD CHEMISTRY OGTT AND GCT OGTT FOR NONPREGNANT ADULT
1. Extract blood for FBS 2. Ask patient to drink 75 grams glucose 3. Get serum glucose 2 hours after drinking.
SCREENING TEST FOR PREGNANT PATIENT (GCT)
1. Ask patient to drink 50grams glucose (24‐28 wks) 2. Get serum glucose 1 hour after drinking.
DIAGNOSTIC TEST FOR PREGNANT PATIENTS (OGTT) 1. Extract blood for FBS. 2. Ask patient to drink 100 grams glucose. 3. Get serum glucose 1 hour after drinking. 4. Get serum glucose 2 hours after drinking. 5. Get serum glucose 3 hours after drinking. BLOOD CHEMISTRY POTASSIUM REAGENT SET (TURBIDIMETRIC)
INTENDED USE
FOR IN VITRO DIANOSTIC USE in the quantitative determination of potassium in serum and urine.
REAGENTS 1. PROCIP REAGENT 2. BORON REAGENT 3. BASE REAGENT 4. POTASSIUM REAGENT
SPECIMEN COLLECTION
SERIUM Collect whole blood by venipuncture and allow to clot. Centrifuge and immediately remove serum. Serum should not be allowed to remain on clot. Prolonged venous statis during venipuncture reportedly (6,7) causes 10‐20% increase in the level. Since the concentration of K
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+ in erythrocytes is about 20 times that in serum or plasma (8), its imperative that hemolysis be avoided. PLASMA Hemolysis‐free plasma may also be used. It must also be rapidly separated from the cells. Of course, anticoagulants containing potassium must not be used. Heparinized plasma is preferred.
MANUAL ENDPOINT PROCEDURE
A. DEPROTEINIZATION 1. Label polyethylene microcentrifuge tubes: UNKOWN(S), STANDARD and CONTROL. 2. Transfer 1.0ml (100ul) of sample to ots respective vial. 3. Add 1.0 ml of ProCip Reagent, cap and mix vigorously. Let stand for at least 3 minutes. 4. Using a 13 x 100 mm test tube as a carrier, centrifuge at 2000 x g (2500‐3000 rpm) for 5 minutes. Test is performed on the supernatant fluid. B. REACTION 1. Label test vials: UNKOWN(S), STANDARD, CONTROL, and REAGENT BLANK. 2. ADD 2.0 ML OF Boron reagent to all vials. 3. Add 2.0 ml (4drops) of base Reagent to each vial and mix immediately. 4. Add 0.5 ml Note: For a direct read‐out instrument, set read‐out to concentration of Standard (5.0 mEq/L). read the unknown concentration directly.
EXPECTED VALUES (6) (500ul) of Supernatant fluid from above to its respective vial and mix by gentle swirling to avoid foaming. Add 0.5 ml of Reagent Grade Water to the REAGENT BLANK and mix. 5. Set wavelength of photometer at 420 nm and zero the instrument with the REAGENT BLANK. Read and record the absorbance of all vials.
Serum 3.6 – 5.5 mEq/l Plasma 3.4 – 4.5 mEq/L Urine 25 – 125 mEq/L
(Varies with diet)
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BLOOD CHEMISTRY SODIUM REAGENT SET (Colorimetric Uranyl Reduction Method)
INTENDED USE
FOR IN VITRO DIANOSTIC USE in the quantitative colorimetric determination of sodium in serum and plasma . REAGENT
1. SODIUM PROCIP REAGENT 2. SODIUM ACID REAGENT 3. SODIUM COLOR REAGENT
PROCEDURE
A. DEPROTEINIZATION 1. Label polyethylene microcentrifuge tubes: UNKNOWN(S), STANDARD, CONTROL, and BLANK. 2. Add 1.0 ml of Sodium Procip Reagent to each vial. 3. Transfer 20 microliters of sample to its vial, cap and mix vigorously. Let stand for 10 minutes in an ice bath (00c). 4.Mix tubes vigorously. Using a 13 x 100 mm test tube a carrier, centrifuge at 2000g (2500‐3000 rpm) for 10 minutes. B. COLOR REACTION 1. Label borosilicate test vials: UKNOWN(S), STANDARD, CONTROL BLANK. 2. Add 1.5 ml of Sodium Acid Reagent to all vials. 3. Carefully transfer 50 microliters of supernatant from DEPROTEINIZATION step above to its respective vial. 4. Add 1.5 ml of Sodium Color Reagent to each vial and mix by gentle swirling. 5. Set the wavelength of the photometer at 550 + 10 nm and zero the instrument with distilled water. Read and record the absorbances of all vials within 60 minutes.
EXPECTED VALUES (7)
Adults………………….. 135 – 155 mEq/L There appears to be significant sex difference. There is a slight increasing after meals.
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BLOOD CHEMISTRY TOTAL CHOLESTEROL (ENZYMATIC METHOD)
INTENDED USE
FOR IN VITRO DIAGNOSTIC USE in the quantitative determination of total cholesterol in serum.
REAGENTS
1. CHOLESTEROL BUFFER 2. CHOLESTEROL ENZYME REAGENT 3. CHOLESTEROL STANDARD
SPECIMEN
Collect whole bloody by venipuncture and allow to clot. Contrifuge and remove serum as soon as possible. Blood should be collected after 12‐16 hours fasting to minimize turbidity; however, the effect of a meal on the cholesterol level reportedly (8) increases the level less than 3%. Cholesterol reportedly (9) decreases during ovulation, increases during sever emotional stress, varies in some individuals on a day –to‐day basis, and exhibits a seasonal variation in healthy young men (9).
MANUAL PROCEDURE
All reagents must attain room temperature (20‐25oC) prior to use.
1. Transfer 2.5 ml of cholesterol Buffer to vials labeled: UNKNOWN‐ (S), STANDARD, CONTROL, BLANK.
2. Add 20 ul (0.020ml) of sample to its respective vial
3. Add 0.1 ml (100 ul) of Chloresterol Enzyme Reagent to all vials, mix and incubate at
37o heating bath for 10 minutes.
4. Zero photometer at 510 nm with the BLANK vial. Read and record the absorbance of all vials.
Note: For a direct read‐out instrument, set read‐out to concentration of Standard (200 mg/d1). Read the Unknown concentration directly.
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Use the absorbance readings of the Cholesterol STANDARD and UNKNOWN (S) to calculate the total cholesterol values as follows: A (U) x C (S) mg/d1 = C (U) mg/d1 A (S)
EXPECTED VALUES AGE (YRS) MALES (mg/d1) FEMALES (mg/d1) 5‐19 125‐191 131‐208 20‐34 118‐258 121‐227 ` 35‐49 147‐275 139‐268 50‐64 156‐287 163‐300 65‐70+ 166‐265 167‐280
‘DESIRED’ RANGE FOR ADULTS (10) 140‐250 mg/d1
PROCEDURE NOTES
1. If the total cholesterol value exceeds 600 mg/d1 or the linear capability of the photometer, dilute the sample 1:1 with distilled water and re‐run the assay; multiply the result by 2.
2. If the sample is extremely lipemic, prepare a sample blank by adding 0.020 ml (20 ul) of sample to 2.5 ml Cholesterol Buffer and add 0.1 ml of distilled water. Mix and measure the absorbance against Cholesterol Buffer. Subtract the value obtained from the value derived in step # 4 of the above procedure; this will yield a corrected absorbance value.
QUALITY CONTROL
Good Laboratory practice requires the use of normal and abnormal control sera at least once daily to monitor test precision and accuracy. We recommend Sterling Normal Control (Cat. # 1003‐N) and Sterling Abnormal Control (Cat. # 1003‐A) for this purpose.
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BLOOD CHEMISTRY CALCIUM (CPC) PROCEDURE
INTENDED USE
FOR IN VITRO DIAGNOSIS USE in the quantitative colorimetric determination of total calcium in serum.
REAGENTS 1. CALCIUM COLOR REAGENT 2. CALCIUM BASE REAGENT 3. CALCIUM STANDARD
SPECIMEN COLLECTION & HANDLING
Collect whole blood by venipuncture and allow to clot. Centrifuge and immediately remove serum. The specimen should be collected from a fasting individual since meals reportedly (9) increase calcium levels as a result of metabolic alkalosis. Serum must be used most anticoagulants interfere with complexometric methods. Once separated from the cells, calcium in serum is stable for 8 hours at room temperature, 24 hours at 40C, and 1 year frozen (10).
MANUAL PROCEDURE
1. Transfer 1.5ml of CALCIUM COLORREAGENT into vials labeled: UNKNOWN(S), STANDARD, BLANK, etc.
2. Add 1.5 ml of CALCIUM BASE REAGENT to all vials and mix by gentle swirling 3. Add 20 ul (0.020ml) of sample to its respective vial, mix by gentle swirling and allow to
stand at room temperature (20‐250C) for at least one (1) minute. 4. Set the wavelength of photometer at 575+5 nm and zero instrument with the BLANK.
Read and record the absorbances of all vials.
Note: For a direct read‐out instrument, set read‐out to concentration of Standard (10mg/dl). Read the Unknown concentration directly.
EXPECTED VALUES
Newborn (4‐7 days) 9.8 – 10.9 mg/dl Children 8.8 – 10.8 mg/dl Adult (M & F) 8.4 – 10.2 mg/dl Adult M>60 yrs 8.4 – 10.0 mg/dl
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PROCEDURE NOTES
1. Preparation of SERUM BLANK for highly lipemic samples: a. Add 20 ul (0.20 ml) of the sample to 3.0 ml of distilled water and mix. b. Read the absorbance of this SERUM BLANK against distilled water at 575+ 5 nm and subtract this absorbance of the UKNOWN (from step #4 of the above procedure). c. Use the corrected absorbance to calculate the calcium value in the UNKNOWN. 2. If any assay value exceeds 15 mg/dl or the linear capability of the photometer, repeat the test on a 1:1 dilution of the sample with distilled water and multiply the result by 2. 3. Contamination of the glassware with calcium, usually from detergents, may be prevented by using acid‐washed glassware.
QUALITY CONTROL
Good laboratory practice requires the use of normal and abnormal control sera at least once daily to monitor test precision and accuracy. We recommended Sterling Normal Control (Cat. # 1003‐N) and Sterling Abnormal Control (Cat # 1003‐A) for this purpose.
BLOOD CHEMISTRY ALBUMIN BCG PROCEDURE
INTENDED USE
FOR IN VITRO DIAGNOSIS USE in the quantitative determination of Serum Albumin.
REAGENTS
1. ALBUMIN BCG REAGENT 2. ALBUMIN STANDARD
SPECIMEN COLLECTION (6)
Collect whole blood, allow to clot, centrifuge and remove serum. Albumin in serum is
reported to be stable for up to 7 days at room temperature, 30 days at 2‐80C, and longer when frozen.
MANUAL PROCEDURE
1. Place 3.0 ml of ALBUMIN BCG REAGENT into test vials labeled: UNKNOWN, CONTROL, STANDARD, BLANK.
2. Transfer 0.010 ml (10ul) of sample to the corresponding vial, mix thoroughly, and allow to stand at room temperature for 5 minutes.
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3. Set wavelength of the photometer at 630 nm and zero the photometer with the BLANK. Read the remaining vials and record the absorbances.
ALTERNATIVE METHOD: The absorbance maybe read at 30‐ seconds.
EXPECTED VALUES (7)
New : 2.8 – 4.4 Gm/dl
(2‐4 days) Adult: 3.4 – 5.0 Gm/dl >60 yrs: 3.4 – 4.8 Gm/dl
PROCEDURE NOTES
1. Albumin levels exceeding 6.0 Gm/dl must be diluted and re‐assayed. Dilute the sample1:1 with0.85% saline, re‐run test and multiply result by 2.
2. SERUM BLANKS must be run with markedly lipemic sample. Simply substitute 3.0 ml of distilled water for Albumin BCG Reagent, add 0.010 (10ul) of sample and take absorbance measurement at 630 nm versus distilled water. Subtract this value from the absorbance value of initial reading of the lipemic specimen in the above procedure.
QUALITY CONTROL
Quality control sera should be used routinely to monitor test precision (11). Refer to the manufactures product insert for analyte stability and acceptable limits. Sterling Normal Control (CAT. # 1002‐4) are recommended for this purpose. BLOOD CHEMISTRY TOTAL PROTEIN INTENDED USE
FOR IN VITRO DIAGNOSIS USE in the quantitative colorimetric determination of Serum Total Protein.
REAGENTS
1. BIURET REAGENT 2. TOTAL PROTEIN STANDARD
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SPECIMEN (4)
Collect whole blood, allow to clot, centrifuge and remove serum. Protein in serum is reported to be stable for up to 7 days at room temperature.
MANUAL PROCEDURE
1. Place 3.0 ml of Biuret Reagent into test vials labeled: UNKNOWN, CONTROL, STANDARD, BLANK.
2. Transfer 0.050 ml (50ul) of sample to the corresponding vial, mix thoroughly (but not vigorously), and allow to stand at room temperature for 10 minutes.
3. Set the wavelength of the photometer at 540 nm and zero the photometer with the BLANK. Read the remaining vials, record the absorbance and proceed to calculation with Example.
NOTE: For a direct read‐out instrument, set read‐out to concentration of Standard. Read the Unknown concentration directly.
EXPECTED VALUES (6)
6.3 – 8.3 Gm/dl
PROCEDURE NOTES
For total protein levels exceeding 15.0 Gm/dl, re‐run the procedure on a 1:1 dilution of sample with 0.85% saline and multiply result by 2.
BLOOD CHEMISTRY LACTATE DEHYDROGENASE (LCH) (COLORIMETRIC METHOD) INTENDED USE: FOR IN VITRO DIANOSIS USE in the quantitative colorimetric determination of lactate dehydrogenase (LDH) in serum. REAGENTS
The following reagents must be stored under refrigeration (2‐80C) and can be used until the expiration date indicated on the individual label.
1. LDH SUBSTRATE 2. LDH COLOR REAGENT 3. LDH CALIBRATOR
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PROCEDURE
All reagents must attain room temperature (20‐250C) prior to use.
1. Label vials: UNKNOWN(S), CONTROL, LDH CALIBRATOR and BLANK. Add 20 microliters of sample to its respective vials.
2. Add 1.0ml of LDH Substrate all vials. 3. Add 100 microliters of LDH Color Reagent to all vials, mix and place in a 370C heating
bath for exactly 10minutes. 4. Add 2.0 ml of 0.1 N Hydrocholoric Acid to each vial to stop the reaction. Mix by gentle
swirling. 5. Zero the photometer at 500nm with the Reagent Blank. Read and record the
absorbance of all samples within 60 minutes.
EXPECTED VALUES (12)
27 – 77 /L (370C or 81 – 231 mU/ml (wacker units; 370C)
PROCEDURE NOTES
Sample Blank Preparation for highly icteric or lipemic specimen: a. Add 20 microliter of sample to 3.1 ml of reagent Grade Water and mix. b. Zero photometer set at 500 nm with Reagent Grade Water and record sample reading. c. Subtract this value from the original absorbance value obtained on the patient sample
and recalculate the LDH value.
QUALITY CONTROL
Good laboratory practice requires the use of normal and abnormal control sera at least once daily to monitor test precision and accuracy. We recommend Sterling Abnormal Controls (CAT # 1003‐N) and Sterling Abnormal Control (CAT # 1003‐A) for this purpose.
BLOOD CHEMISTRY ALKALINE PHOSPHATASE
INTENDED USE
For the Quantitative Determination of Serum Alkaline Phosphatase.
REAGENTS
The following reagents should be stored at 2‐80C and can be used until the expiration date indicated on the individual bottles.
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REAGENTS
1. ALP SUBSTRATE 2. ALP ACTIVATOR 3. ALP DILUENT 4. ALP STANDARD (50 IU/L)
SPECIMEN COLLECTION (3,4)
Collect whole blood by venipuncture and allow it to clot. Centrifuge and remove serum.
Hemolysis must be avoided since ALP in erythrocytesis six times the concentration found in normal serum. Serum must be used for this assay because most anticoagulants nhibit ALP activity. Serum should be separated from the cells within 2 hours following collection and, if not assayed promptly, serum should be refrigerated at 2‐80C. If storage is to exceed 2‐3 days, serum should be frozen and stored at 200C. Please note that ALP activity recovers slowly after thawing of frozen serum.
PROCEDURE All reagents must attain room temperature (20‐250C) prior to use. 1. Add 1 drop of ALP Activity to all vials labeled:UNKNOWN (S), CONTROL, STANDARD and BLANK. 2.Add 50ul of sample to its respective vial. 3. Add 1.0ml of ALP Substrate to all vials, mix by shaking entire rack, and immediately place in 370C heating bath for exactly 10 minutes. 4. Add 2.0 ml of ALP DILUENT to all vials and mix. 5. Zero photometer at 590 nm with Reagent Grade Water. Note: For a SA‐2000 Chemistry Analyzer, read STANDARD and sample against BLANK.
EXPECTED VALUES (8) 9 – 45 AT 370C
PROCEDURE NOTES
1. If the sample is lipemic, highly icteric or contains BSP, a SERUM BLANK should be included as follows: a. Add 1.0 ml of ALP SUBSTRATE, 1drop of ALP ACTIVATOR and 2.0ml of ALP DILUENT to a test vial that is identical to that used in above MANUAL PROCEDURE. b. Transfer 0.050 ml (50 ul) of sample to vial and mix by gentle swirling. c. Read and record the absorbance of the SERUM BLANK vs. the Reagent BLANK in SA‐2000 Chem Analyzer.
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d. Calculate as follow: [a (Serum)‐a (Serum Blank)] /a (Standard) X Concentration of Standard (IU/L) = ALP Concentration in serum (IU/L) BLOOD CHEMISTRY TROPONIN T SENSITIVE RAPID ASSAY
PROCEDURE: 1. Remove the strip from the package and place it on a flat surface. 2. Obtain the blood sample collected at EDTA tubes. 3. Draw up 150 ul blood into the dispensing aid. 4. Apply the sample to the test strip and read result after 15 minutes. INTERPRETATION OF RESULTS: NEGATIVE‐ only single line at control line POSITIVE ‐ two lines appear at the test and control line
BLOOD CHEMISTRY TROPONIN I
SPECIMEN COLLECTION AND STORAGE: 1.Serum 2.Whole blood. Collect blood in a tube containing citrate as the anticoagulant. Fresh specimen are recommended since the cardiac troponin proteins are unstable.Whole blood sample should be tested within four hours. PROCEDURE: 1. Refrigerated specimen or other test materials including devices must be equilibrated to room temperature before testing to avoid invalid results. 2. Remove the device from the pouch and place it on a flat surface. Label the device with specimen identification. 3. Add four drops of whole blood or serum ( about 160 ul – 200 ul } into the sample well. 4. Strong positive results may be observed within five minutes. Weak positive results may take a longer time. THE RESULTS SHOULD BE READ WITHIN 15 –20 MINUTES. DO NOT INTERPRET THE RESULTS AFTER 20 MINUTES. INTERPRETATION OF RESULTS: 1. POSITIVE – If both the C line and T line appear, the results indicates that the cardiac
troponin is detected and the result is positive.
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2. NEGATIVE. If only the C line appears, the test indicates that no cardiac troponin is detected or its level is below the detectable.
3. INVALID ‐ When no control line appears within 5 minutes. Repeat the test with a new test device.
BLOOD CHEMISTRY CREATINE KINASE‐MB (CK‐MB) INTENDED USE CK‐MB is intended to measure the activity of isoenzyme CK‐MB in human serum at 340 nm. PROCEDURE (MANUAL)
1. Reconstitute CK‐MB reagent according to instructions. 2. Pipette 1.0 ml of CK‐MB reagent into the appreciate test tubes and pre‐warm at
37oC for least two (2) minutes. 3. Zero spectrophotometer with water at 340 nm. 4. Add 0.050 ml (50 ul) of sample to the reagent, mix, and incubate at 37oC for five (5)
minutes. 5. After five minutes, read and record the change in absorbance per minute for two (2)
minutes 6. Calculate the average absorbance difference per minute (Abs./min.). 7. The Abs./ min. Multiplied by the factor 3376 (see calculations) will yield CK‐B results
in IU/L. 8. Sample with values above 1500 IU/L should be diluted 1:1 with saline, re assayed,
and the result multiplied by two (2). Note: If the spectrophotometer being used requires a final volume greater than 1.0 ml for accurate readings, 3.0 ml of reagent and 0.15 ml (150 ul) of sample can be used. If the spectrophotometer being used is equipped with a temperature‐controlled cuvette, the reaction mixture may be left in the cuvette while readings are taken.
EXPECTED VALUES 0‐24 IU/L (37oC)
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BLOOD CHEMISTRY PHOSPHORUS UV
Samples Serum free of hemolysis Heparin plasma Urine dituled 1/10 with distilled water References Values Serum 2.7 – 4.5 mg/dL 27 ‐ 45 mg/L 0.87 – 1.45 mmol/ L Urine 325 – 900 mg/24h 10.4 – 28.8 mmol/24h Procedure Wavelength : 340nm Temperature : 250C, 300C, 370C Cuvette : 1 cm light path Read against reagent blank BLANK STANDARD SAMPLE Working Reagent Distilled water Standard Sample
1 ml 10 ul ‐ ‐
1 ml ‐
10ul ‐
1 ml ‐ ‐
10ul
Mix and read the optical density (OD) after a 5 minutes incubation. The final colour is stable for at least 1 hour.
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SPECIAL TEST HEPATITIS B SURFACE ANTIBODY SPECIMEN COLLECTION AND STORAGE: Collect blood aseptically by venipuncture into a clean tube without anticoagulants. Permit blood to clot for twenty to thirty minutes at room temperature.Centrifuge To obtain clear serum and transfer serum into a clean glass tube.The test may be Performed using human serum or plasma. TEST PROCEDURE: NOTE: Bring test components and specimens to room temperature prior to testing. 1. Open a foil pouch, remove the Testing Device and place it on a clean,level surface. 2. Holding the dropper provided vertically, add exactly four drops of serum to the sample well “S”. 3. Read the test result at ten minutes. IMPORTANT: A POSITIVE RESULT should not change once established at 10 minutes; however , in order to prevent an incorrect reading, do not interpret the test result after more than ten minutes. INTERPRETATION OF RESULTS: 1. POSITIVE.Two pink‐rose bands appear; one in the test zone “T” and in the control zone “C”. A positive result indicates the presence of the antibody to hepatitis B antigen. 2. NEGATIVE.One pink‐rose band appears in the control zone “C”, with a band in the test zone ”T”. A negative result indicates the antibody to hepatitis B antigen is not present, or its level is below the sensitivity of the test. 3. INVALID. If there is no distinct color band visible both in the test zone and in thecontrol zone, or there is a visible band only in the test zone and not in the control zone,then the test is INVALID.
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SPECIAL TEST HEPATITIS B SURFACE ANTIGEN Screening Test
SPECIMEN COLLECTION AND STORAGE: 1.Serum is obtained by following regular clinical procedures. If the specimen is not tested the same day as collection, it should be sealed and refrigerated. If not tested with in 3 days of collection ,the specimen should be frozen. Avoid thawing and refreezing of the specimen. Sodium azide can be added as a preservation up to 0.1% without any effect on the assay. 2.If specimens are to be shipped, they should be packed in compliance with federal regulations covering the transportation of etiologic agents. 3.Specimens containing precipitate may yield inconsistent test results. Such specimens must be clarified prior to assaying. PROCEDURE: 1.Bring all reagents and samples to room temperature. 2.Remove the test device from its foil pouch. 3.Dispense 200 ul about 4 drops of serum sample into the sample well with a clean pipette. 4.Read the result within 10 minutes for 5ng/ml, or within 30 minutes for 1ng/ml. Note: Do not interpret the result after 330 minutes. INTERPRETATION OF RESULTS: 1. NEGATIVE: Only one colored band appears on the control region. 2. POSITIVE: In addition to the control band, a distinct colored band also appears on the test region. SPECIAL TEST SD DENGUE IgG/ IgM PROCEDURE OF THE TEST 1. Allow all kit components and specimen to room temperature prior to testing. 2. Add 4 drops (about 140 ul ) of assay buffer to each disposable test tube. 3. Using the loops provided (*), add 1 ul of specimen to test tube containing assay buffer. (* Dip the circular end of the specimen loop into the specimen, and then carefully place the circular end of the loop into the test tube. This will add 1 ul of specimen to assay buffer.)
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4. Gently stir the assay buffer with the loop to ensure adequate mixing of the specimen in the assay buffer and remove the loop. 5. Remove the test strip from the foil pouch prior to use. 6. Holding the strip vertically, insert the test strip into the tube containing 7. Interpret test result at 15‐30 minutes. If the test band is very faint at 15 minutes, please read the results again at 30 minutes. INTERPRETATION OF THE TEST IgG and IgM positive The control line ,IgM (M) and IgG (G) are visible on the test strip. This is positive for both IgM and IgG antibodies. This is indicative of late primary or early secondary dengue infection. IgM Positive The control line (C) and IgM line (M) are visible on the est strip. This is positive for IgM antibodies to Dengue virus. This is indicative of a primary Dengue infection. IgG positive The control line, IgG (G) are visible on the test strip. This is positive IgG antibodies.This is indicative of secondary or past dengue infection. Negative The control line is only visible on the test strip.No IgG and IgM antibodies were detected. Retest in 3‐5 days if dengue infection is suspected. SPECIAL TEST SD SALMONELLA TYPHI IGG / IGM Procedure of the test
- Allow all kit components and specimen to room temperature prior to testing.
- Add four drops about 20ul assay buffer to each disposable test tube.
- Using the loops provided add 1 ul of specimen to test tube containing
assay buffer. DIP the circular end of the specimen loop into the specimen , and then carefully place the circular end of the loop into the test tube. This will add 1 ul of specimen to assay buffer.
- Gently stir the assay buffer with the loop to ensure adequate mixing of the serum in the assay buffer and remove the loop.
- Remove the test strip from the foil pouch prior to use. - Holding the strip vertically , insert the test strip into the tube
containing diluted specimen.
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- Interpret test results at 15 to 30 minutes.If the test band is very faint at 15 minutes , please read the results again at 30 minutes.
INTERPRETATION OF THE TEST IgM Positive
The control line (C) and IgM line (M) are visible on the test strip. This is Positive for IgM antibodies to Salmonella typhi. THIS IS INDICATIVE OF ACUTE TYPHOID FEVER. IgG and IgM Positive The control line, IgM (M) and IgG line (G) are visible on the test strip. This is positive for both IgM and IgG antibodies. This is indicative of ACUTE THYPOID FEVER in the middle stage of salmonella typhi infection. IgG Positive The control line and IgG line (G) are visible on the test strip.This is positive for IgG antibodies.This is indicative of previous Salmonella typhi or relapse or re‐infection NEGATIVE The control line is only visible on the test strip. No IgG and IgM antibodies were detected. Probably NOT THYPOID.
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SPECIAL TEST WIDAL TEST Procedure:
1. Deliver 0.08, 0.04, 0.02, 0.01 and 0.005 ml of the serum to the squares in each row. 2. Add to each row 0.03 ml of antigen suspensions and mix with applicator sticks. 3. Rock the slide on the illuminated box for 3 mins. And read the agglutination. 4. The degree of agglutination is read in accordance with the following scale:
Complete agglutination 4+ 75% agglutination 3+ 50% agglutination 2+ 25% agglutination 1+
5. The serum dilutions on the slide are considered to correspond with the following dilutions in the test:
0.08 ml serum 1/20 0.04 ml serum 1/40 0.02 ml serum 1/80 0.01 ml serum 1/160 0.005 ml serum 1/320
• The liter of the serum against the antigen is considered to be shown by that serum
giving a 2 plus agglutination.