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Get the Hematology Eqas Registration Form 2017-2023
Health
Research Institute for Tropical Medicine
LABORATORY ENROLLMENT FORM
Lab ID No:
(NEQAS USE)
PLEASE WRITE LEGIBLY IN BLOCK AND ALL CAPITAL LETTERS. DO NOT LEAVE ANY SPACES BLANK.IF NOT APPLICABLE, WRITE N/A
*KINDLY SUBMIT THE ORIGINAL COPY DURING REGISTRATION
1. Name of laboratory/hospital (No abbreviations please):
2. Address:
No, Street
Barangay
Municipality/City
Province
Postal Code
3. Tel:
4. Fax:
5. Web/E-mail:
6. Contact Person:
7. Contact Person Tel/mobile No:
8....
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