Beruflich Dokumente
Kultur Dokumente
Department of Health
LCP FORM NO. 22 302
Lung Center of the Philippines GENERAL INFORMATION SHEET
NATIONAL REFERENCE LABORATORY Revision 04
Department of Pathology and Laboratory February 2017
Quezon Avenue Ext., Quezon City Website: lcp.gov.ph Page 1 of 1
Telefax : 924-6101 loc. 388 / 590 E-mail: lcpnrlcc2007@gmail.com
1. Complete all data required herein. For changes, please notify LCP-NRL. Participation to NEQAS-CC
2. Submit on or before: JUNE 15, 2017 Initial Renewal
2.1. All original LCP-NRL 2017 NEQAS-CC Forms Please check history of Participation
2.2. Photocopy of 2017 LICENSE TO OPERATE 2007 2012
2.3. Machine validated transaction/deposit slip 2008 2013
- if payment is made via bank to bank 2009 2014
3. Incomplete requirements shall NOT be processed. Registration Forms 2010 2015
sent via email or fax are NOT ACCEPTABLE. 2011 2016
GENERAL INFORMATION
Name of Clinical Laboratory (based on your License to Operate)
2.
3.
Mode of Over the Counter O.R. No: Control No.: 2017 - __________
(NRL code)
Payment: Cash O.R. Date:
Check Amount: Date: _____________
Bank to Bank
Date of deposit: _________________
Republic of the Philippines
LCP FORM NO. 22 304
Department of Health
Lung Center of the Philippines ORDER OF PAYMENT FORM
NATIONAL REFERENCE LABORATORY for NEQAS PARTICIPATION
Department of Pathology and Laboratory Revision 04
Quezon Avenue Ext., Quezon City Website: lcp.gov.ph February 2017
Telefax : 924-6101 loc. 388 / 590 E-mail: lcpnrlcc2007@gmail.com Page 1 of 1
NEQAS FOR CLINICAL CHEMISTRY for the year 2 0 1 7 FOR LCP - NRL FILE COPY
NEQAS FOR CLINICAL CHEMISTRY for the year 2 0 1 7 FOR LCP - CASHIER DIVISION
Mode of Payment:
Cash Bank to Bank PARTICIPATION FEE: P 8,000.00
Check Over the Counter ( NON-REFUNDABLE, NON-TRANSFERABLE AND
CANNOT BE USED AS ADVANCED PAYMENT
(For the Check payments only: kindly provide the ff. details) FOR THE NEXT NEQAS-CC CYCLE )