Data Submission Form Vit A

Vitamin A Laboratory - External Quality Assurance Program (VITAL-EQA)

Round 35 / Fat Solubles / Retinol

INSTRUCTIONS

• E-mail this completed worksheet to: vitaminalab@cdc.gov

• Round deadline:

December 18, 2020

• All cells highlighted red are required or have invalid data that needs to be revised. Click on cell to see data requirements.

• Run these samples in the same way as you would routine patient samples.

• Run in singlicate over a period of two consecutive days (Day 1 and Day 2).

• Record all results with three significant figures (i.e., 105, 10.5, 1.05, 0.105).

• Retain the vials in your ultra-cold freezer for at least two weeks after data submission in case there is a question about the ID code or results.

Laboratory ID

Received Date (MM/DD/YY)

Assay Type

Instrument

(Manufacturer/Model)

Kit Information (if used)

(Name/Manufacturer)

Low

High

Calibration Range

µg/dL

µg/dL

LOD

µg/dL

Run

Assay Date

Sample ID

Result (µg/dL)

< LOD

Note

1

1

1

1

2

1

1

1

Laboratory Notes

OFFICIAL USE ONLY