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[null,"C-QAS Registration form"]
[]
["Practice ref (office use only)"]
[]
["Thank you for your interest in C-QAS. C-QAS is an external quality assurance scheme for veterinary practice biochemistry and haematology analysers. Please complete all sections coloured red and email the form to c-qas@sac.co.uk."]
["For further information see the C-QAS website (www. cqas.co.uk), email c-qas@sac.co.uk, or phone 01315353145"]
[]
["Practice address"]
["Name:"]
["Address 1:"," "]
["Address 2:"]
["Town"]
["County"]
["Post code"]
["Phone number:"]
["Fax number"]
[]
["Billing Address (if different to Practice address)"]
["Name:"]
["Address 1:"]
["Address 2:"]
["Town"]
["County"]
["Post code"]
["Phone number:"]
["Fax number"]
[]
["Practice contact (preferably the practice QA manager) to whom all correspondence will be addressed:"]
["Contact position / job title:"]
["Contact e-mail:"]
[]
["How many analysers are you registering? Enter 0 if not registering an analyser."]
["Biochemistry:"]
["Haematology:"]
[]
["Analysers listed on this form will be registered under the same address and all samples and correspondence relevant to the analysers will be issued to that address. If you wish to register analysers at branch practices, please complete a separate form for each address and enter here the name and address of the main practice premises. If registering one address only leave this box blank."]
[]
[]
["Are you a member of a buying group Y/N?"]
["Name of group"]
[]
["Set your profile"]
[]
["Biochemistry","Please indicate with a Y which analytes you wish to register for in your proflie. Leave boxes blank for those analytes you are not registering for. Measured parameters only are listed. Glonulin is a calculated value and therefore not included. Where insufficient practices register for an analyte the analyte may not be included in the scheme.","Units used by your analyser (amend if different)"]
["Albumin",null,"g/l"]
["ALP",null,"iu/l"]
["ALT",null,"iu/l"]
["Amylase",null,"iu/l"]
["AST",null,"iu/l"]
["BA",null,"µmol/l"]
["β-OH butyrate",null,"mmol/l"]
["Bilirubin total",null,"µmol/l"]
["Calcium",null,"mmol/l"]
["Chloride",null,"mmol/l"]
["Cholesterol",null,"mmol/l"]
["Creatine kinase",null,"iu/l"]
["Creatinine",null,"µmol/l"]
["GDH",null,"iu/l"]
["GGT",null,"iu/l"]
["Glucose",null,"mmol/l"]
["LDH",null,"iu/l"]
["Lipase",null,"iu/l"]
["Magnesium",null,"mmol/l"]
["Phosphate",null,"mmol/l"]
["Potassium",null,"mmol/l"]
["Sodium",null,"mmol/l"]
["Thyroxine",null,"nmol/l"]
["Total protein",null,"g/l"]
["Triglyceride",null,"mmol/l"]
["Urea",null,"mmol/l"]
[]
["Please indicate any other parameters you wish to be included"]
[null,"Analyte","Units used by your analyser"]
{"$rows_empty":7}
["Other parameters you request will only be considered if sufficient numbers of other participants also subscribe to the parameter"]
[]
[]
[]
["Haematology:","Please indicate with a Y which parameters you wish to include in your profile. Measured and calculated parameters are listed. Leave boxes blank for those analytes you are not registering for. Where insufficient practices register for an analyte the analyte may not be included in the scheme.","Units "]
["Red cell count",null,"x1012/l"]
["Hb",null,"g/l"]
["PCV",null,"l/l"]
["MCV",null,"fl"]
["MCH",null,"pg"]
["MCHC",null,"g/l"]
["Platelets",null,"x109/l"]
["MPV",null,"fl"]
["PDW",null,"%"]
["White cell count",null,"x109/l"]
["Neutrophil (mature) - count",null,"x109/l"]
["Neutrophil (immature) - count",null,"x109/l"]
["Lymphocyte - count",null,"x109/l"]
["Monocyte - count",null,"x109/l"]
["Eosinophil - count",null,"x109/l"]
["Basophil - count",null,"x109/l"]
["For individual cell counts it is the actual count not the % that should be reported"]
[]
["Please indicate any other haematologic parameters you wish to include in your profile"]
[null,"Analyte","Units used by your analyser"]
{"$rows_empty":8}
["Other requested parameters will only be considered if sufficient numbers of other participants also subscribe to the parameter"]
[]
[]
["Analyser details"]
["State the make and model of your analyser(s). An identification number will be assigned to each analyser and will be confirmed once your registration form has been processed. The \"Your reference\" box is for your use only and allows you to identify which analyser the Analyser Reference refers to when you are registering more than one analyser. "]
[]
["Biochemistry 1"]
["Make of analyser"]
["Model of analyser"]
["Your ref"]
["Analyser Reference (office use only)"]
[]
["Biochemistry 2"]
["Make of analyser"]
["Model of analyser"]
["Your ref"]
["Analyser Reference (office use only)"]
[]
["Biochemistry 3"]
["Make of analyser"]
["Model of analyser"]
["Your ref"]
["Analyser Reference (office use only)"]
[]
["Haematology 1"]
["Make of analyser"]
["Model of analyser"]
["Your ref"]
["Analyser Reference (office use only)"]
[]
["Haematology 2"]
["Make of analyser"]
["Model of analyser"]
["Your ref"]
["Analyser Reference (office use only)"]
[]
["Haematology 3"]
["Make of analyser"]
["Model of analyser"]
["Your ref"]
["Analyser Reference (office use only)"]
[]
[]
["If you are a member of another EQA scheme please indicate the month and year you wish your registration with C-QAS to commence. An invoice for your subscription to C-QAS will be issued in the month prior to your chosen start month, and samples will be sent from the month you specify."]
["Month"]
["Year"]