A.09.03_9-Attach_6_CAP_Laboratory_Sample_Report.pdf
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- Attached to
- Medical Laboratory Testing Services for HIV
- Solicitation number
- W81K04-18-R-0004
- Issued by
-
Department of the Army Medical Command
About this file
This notice provides details for an upcoming solicitation seeking medical laboratory testing services for HIV. The Health Readiness Contracting Office intends to issue a request for proposal for an indefinite delivery indefinite quantity single award task order contract with a five year ordering period. Interested offerors should monitor the Federal Business Opportunities website for release of the solicitation anticipated on or around April 24, 2018. The solicitation will use the tradeoff source selection process and be available electronically only. A pre-proposal conference is scheduled for approximately 15 days after solicitation release. Offerors should submit any questions on the draft solicitation, exhibits or sample spreadsheet using the provided template to the contracting officer and contract specialist. The North American Industry Classification code for this requirement is 621511 for medical laboratories.
Attachment 6 - CAP Laboratory Sample Report
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Text version
AU ID:
CAP #:
This report is for informational use only. Do not submit data changes on this form.
Laboratory Data Report
SAMPLE REPORT
Demographics
Institution Name:
Laboratory Name:
Physical Location:
Business Mailing Address:
Business Shipping Address:
Laboratory Phone Number:
Laboratory Fax Number:
1 hour Security Notification Laboratory Telephone Number:
Institution Type Institution Type:
Administration
Laboratory Director (MD, PhD, DO):
Consulting Pathologist:
Chief Executive Officer (CEO):
Chief of Medical Staff and Specialty:
Laboratory Administrator/Manager:
QA Contact:
Contact for Accreditation Proficiency Testing Monitoring:
Contact for Accreditation:
Laboratory Team Leader:
Staff Pathologists:
College of American Pathologists
4/9/2018 12:46:47 PM
Report created on:
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This report is for informational use only. Do not submit data changes on this form.
Laboratory Data Report
SAMPLE REPORT
Licensure and Certification Joint Commission Number:
CLIP Certification
Hours of Operation and FTEs Bed Count:
Days of Operation:
Sunday
Saturday
Friday
Thursday
Wednesday
Tuesday
Monday
Other Schedule:
Full-Time Equivalents:
Pathologist:
Other MD or PhD:
Scientific and Technical:
Full-time equivalents are calculated by dividing the total number of employee hours worked by 2080 (total number of work hours in one year).
Affiliated Laboratories
Primary Laboratory Name:
CAP Number:
AU ID:
Health System or Associated Group:
Security Clearance
College of American Pathologists
4/9/2018 12:46:53 PM
Report created on:
This report is for informational use only. Do not submit data changes on this form.
Laboratory Data Report
SAMPLE REPORT
Section ID:
Section Name:
Section Demographics
Responsible MD, PhD or DO:
Other Responsible Individual(s) (MT, MS, PhD, etc.):
CMS non-reported:
CMS reported:
Annual Test Volume
Laboratory Information System
Full Time Equivalents:
Scientific & Technical FTEs:
Name Primary LIS:
Additional LIS:
Subdiscipline Activity
ID Test/Activity Category
Section Activities
Director/Organizational Assessment
Scope of Service/Analytic Method
Laboratory General Scope of Service/Analytic Method
College of American Pathologists
4/9/2018 12:46:53 PM
Report created on:
This report is for informational use only. Do not submit data changes on this form.
Laboratory Data Report
SAMPLE REPORT
Section ID:
Section Name:
Section Demographics
Responsible MD, PhD or DO:
Other Responsible Individual(s) (MT, MS, PhD, CMS non-reported:
CMS reported:
Annual Test Volume:
Full Time Equivalents:
Refer to the Laboratory Accreditation Manual, Appendix B to calculate test volumes.
Full-time equivalents are calculated by dividing the total number of employee hours worked by 2080 (total number of work hours in one year).
Scientific & Technical FTEs:
Subdiscipline Activity
ID Test/Activity Category
Section Activities
All Common Scope of Service/Analytic Method
4334 Common (CAP Office use) Molecular Microbiology
Scope of Service/Analytic Method
3484 Molecular infectious disease testing 3485 Nucleic acid amplification
Reportable Assays - Extended List
2420 HIV-RNA, quant, amplification (FDA-approved)
3569 HIV genotyping (FDA-approved) 3956 HIV qualitative, amplification (FDA-approved)
College of American Pathologists
4/9/2018 12:46:53 PM
Report created on:
robert.l.nace Highlight robert.l.nace Highlight robert.l.nace Highlight robert.l.nace Highlight robert.l.nace Highlight
Laboratory Data Report
SAMPLE REPORT
This report is for informational use only. Do not submit data changes on this form.
Section Activities (Continued) Section ID:
Section Name:
Subdiscipline Activity
ID Test/Activity Category
Special Chemistry Scope of Service/Analytic Method
1788 Enzyme-linked immunosorbent assay (ELISA) 3346 Western blot
Reportable Assays - Extended List
1688 HIV-1/2 antibody, non-rapid method
3154 HIV western blot/immunoblot 3307 HIV-1/2 antibody/p24 antigen,non-rapid immunoassay
Reportable Assays - Basic List
AU ID:
CAP #:
College of American Pathologists
4/9/2018 12:46:55 PM
Report created on:
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