ACCREDITATION COMMISSION FOR CONFORMITY ASSESSMENT BODIES Suite # 113-114, Level 1, Master Mind IV, Royal Palms, Aarey Colony, Goregaon East, Mumbai – 400 065. India. Tel/Fax: 91-22-28794410, 28794411, 28794412 E-Mail: info@accab.org Website: www.accab.org RECOMMENDED AUTHORIZED SIGNATORIES ISO 15189 : 2012 Medical Laboratories - Requirement for quality and competence Laboratory : Date(s) of Visit: Reference No.: Note: Any changes in the Authorized Signatories shall be informed by the laboratory to ACCAB within 15 days. The following persons have been recommended as Authorized Signatories for authenticity of Medical Test Reports: Discipline(s) : Sr. No. Laboratory/ Department/ Section Name & Designation of Signatory Qualification with Specialization Experience in years for authorized area Relevant Training Authorized for which specific area Reference to Relevant National /International/ Statutory / Established Clinical Practices /Benchmarks; as applicable Specimen signature Signature: Name: Designation: Head of Laboratory Lead Assessor Date: CRA-F-11-15189 RD-00-01/01/2013 Page 1 of 1