MPV Micronutrients MBA Enrollment Section on Data Submis

NCEH DLS Laboratory Quality Assurance Programs

Att 3h. MPVMicro Enroll&DataReturn.xlsx

MPV Micronutrients MBA Data Submission Form (Private Research Lab)

OMB: 0920-1389

Document [xlsx]
Download: xlsx | pdf

Overview

Micronutrients Report Form
List


Sheet 1: Micronutrients Report Form















CDC Method Performance Verification Program






Micronutrients Method Comparison



















Instructions






· Enter information only in the yellow shaded cells. Cell will become green when populated












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












· Run the samples designated for each day in duplicate over a period of 4 days.












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












· E-mail this completed worksheet to: micronutrbiomarkers@cdc.gov












· Retain the vials in your freezer in case of any questions regarding the ID or results.



























Laboratory Details:

Laboratory ID#











Name of Laboratory























Shipment Details:

Shipment received date













Was the shipper received cold?













Did shipper contain a temperature monitor?













Color of dot on temperature monitor

























Assay Details: Matrix










Analyte










Units

























Assay
























Instrument
(Manufacturer/Model)







(if a kit used) Kit Details
(Name/Manufacturer)






















Calibrator(s) (if available)

























Calibration Range:













Low
0











High
0











LOD
0























Run Assay Date Sample Sample ID Result 1 Result 2 Notes






0 0






Day 1
1










2








3








4








5








6








7








8








9








10








QC1








QC2










Day 2
1










2










3










4










5










6










7










8










9










10










QC1










QC2










Day 3
1










2










3










4










5










6










7










8










9










10










QC1










QC2










Day 4
1










2










3










4










5










6










7










8










9










10










QC1










QC2

























Laboratory Notes




































































































Sheet 2: List

Chromatographic/LC-MS/MS [should not include MeFox]
Chromatographic/HPLC-UV
Immunoassay/Protein Binding Assay
Microbiologic Assay
Other (Please Describe Below)

5-MethylTHF
Folic Acid
Do not know
Other (Please Describe Below)

Serum
Whole Blood

AGP
CRP
Ferritin
Folate
sTfR
Vitamin A
Vitamin B12
Vitamin D

nmol/L
µmol/L
ng/mL
µg/dL
pg/mL
mg/L

Yes
No

No Color
Pink/Red
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