POCT Forms

General Forms

• Temperature Range and Log

Breakdown/ Issue Reporting Form

Internal Quality Control Log Sheet

• Glucose/Ketone

Patient Results Log Sheet Template
If a different format (e.g. book) is used for patient result logging, all required components from the provided log template for each device MUST be included.

• Glucose/Ketone

• Dengue Combo

• DOA (4-panel)

• DOA (10-panel)

• HIV

• Rapid Test Kit - UPT/Hepatitis B/ Hepatitis C/Syphilis

External Quality Control form

• Blood gas

  • Blood Gas EQA Results Submission Checklist

  • Blood Gas EQA Troubleshooting Form