Kingdom of Saudi Arabia General Directorate of Health Affairs in Asser Region Laboratory & Blood Bank Biomed # B – GL DAY Company: ACCU-CHECK Control Low (mg/dl) Result LOT # POCT Coordinator Control High (mg/dl) Expiry Date / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / Ward: CCU / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 Result LOT # Strips Expiry Date / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / Month: / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 LOT # Expiry Date / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / Cleaned Device Initials / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 Created by : Hanadi Al-Yanbawi Laboratory POCT Coordinator 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Glucometer Daily QC Form PFKCC/POC/F001 Laboratory Director Kingdom of Saudi Arabia General Directorate of Health Affairs in Asser Region Laboratory & Blood Bank Glucometer Daily QC Form Biomed # B – GL 098 Company: ACCU-CHECK Control Low (mg/dl) Control High (mg/dl) DAY Result LOT # / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / POCT Coordinator / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 Result LOT # Expiry Date / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 LOT # Month: September Expiry Date / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / Cleaned Device Initials / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 Created by : Hanadi Al-Yanbawi Laboratory POCT Coordinator 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Expiry Date Ward: 3A Strips PFKCC/POC/F001 Laboratory Director Kingdom of Saudi Arabia General Directorate of Health Affairs in Asser Region Laboratory & Blood Bank Glucometer Daily QC Form Created by : Hanadi Al-Yanbawi Laboratory POCT Coordinator POCT Coordinator PFKCC/POC/F001 Laboratory Director