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JABATAN KESIHATAN NEGERI KELANTAN APPENDIX 1
MAKMAL KESIHATAN AWAM KOTA BHARU
LOT 522, KM 10 JALAN KUALA KRAI Document Number MKAKB/BP/BR-05
16010 KOTA BHARU KELANTAN Issue Number 01
01
Amendment Number
NO. TELEFON : 09-7138000 Issue Date 01.08.2023

REFERRAL LABORATORY AND CONSULTANT EVALUATION

1. Laboratory/ Unit:

2. Contact person

Name : Designation : Contact No.:

3. Laboratory accreditation and certification (please tick where applicable)

MS ISO 9001 MS ISO 15189 MSQH Other certification
(please state) ………………

4. Is staff training and competency regularly conducted and monitored? Yes No

5. Referred test particulars:

Test Method L-TAT Notification of critical
results to the requestor
(Yes/No)

6. Enrollment in External Quality Assurance Program for referred test:

Yes No

If Yes, please state the specific provider, name of program and current performance (Please use
a separate sheet if necessary)

Test Program Name EQA Provider Performance
(acceptable/not
acceptable)

8. Consultant particulars (to be filled for consulted case) :

Name :
Qualification and year :

(Note: Please attach supporting documents for item no. 2, 5, 6 as and when necessary)

Prepared by: Approved by:

Date: Date:

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