Complaint Rapid Test

Product Name: *

Hospital/Clinic Lab Name: *

State: *

City: *

Contact Number: *

Lot. No.: *

Name of Distributor: *

Date of Purchase: *

Quantity Purchase: *

Quantity in Stock: *

Description of Complaint: *

Is Complaint Sample Repeated After Centrifugation: *YesNo

Result of Repeated Test: *

Is Complaint Sample Checked With Any Other Company: *YesNo

Result on Competitor Kit: *

Result on Confirmatory Test: *PositiveNegative

is Complaint Verified By Confirmatory Test: *YesNo

Is Complaint Sample Available in Lab: *YesNo

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