List of Approved Referral Laboratories and Consultants template
A form in the Referral Laboratories and Consultants procedure (PR04), mapped to ISO 15189:2022 clause 6.8. Fill it in whenever the task occurs. Used by the quality-management team.
FormISO 15189 · 6.8As needed
Calculated automaticallyRed = outside limits
Your LaboratoryList of Approved Referral Laboratories and Consultants | YL-QM-FRM-04-F04 v1.0
Record: List of Approved Referral Laboratories and Consultants — October 2026
Register a provider only after sufficient evidence of evaluation (PR04, 5.3.4). Review at least annually and update when accreditation status changes.
| No. | Name | Type | Examinations / services | Accreditation body & no. | Accreditation expiry | MOU ref & expiry | Last evaluation | Next evaluation | Status |
|---|---|---|---|---|---|---|---|---|---|
| 1 | R. Naidoo | Referral laboratory | Glucose | REF-26-001 | 2026-10-01 | 2026-10-01 | Approved | ||
| 2 | S. Dlamini | Referral laboratory | Creatinine | REF-26-002 | 2026-10-08 | 2026-10-08 | Approved | ||
| 3 | A. Mensah | Referral laboratory | ALT | REF-26-003 | 2026-10-15 | 2026-10-15 | Approved | ||
| 4 | L. Banda | Referral laboratory | Haemoglobin | REF-26-004 | 2026-10-22 | 2026-10-22 | Approved | ||
| 5 | K. Otieno | Referral laboratory | Potassium | REF-26-005 | 2026-10-29 | 2026-10-29 | Approved | ||
| 6 | T. Moyo | Referral laboratory | Glucose | REF-26-006 | 2026-11-05 | 2026-11-05 | Approved | ||
| 7 | R. Naidoo | Referral laboratory | Creatinine | REF-26-007 | 2026-11-12 | 2026-11-12 | Approved | ||
| 8 | S. Dlamini | Referral laboratory | ALT | REF-26-008 | 2026-11-19 | 2026-11-19 | Approved |
Sign-off
| Role | Name | Signature | Date |
|---|---|---|---|
| Reviewed by (Laboratory Manager) |
Shaded cells are calculated automatically. Values in red are outside their limits. † marks a corrected value (see Corrections).
Controlled document. Printed copies are uncontrolled unless stamped.Page 1
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What it records
- Name
- Type
- Examinations / services
- Accreditation body & no.
- Accreditation expiry
- MOU ref & expiry
- Last evaluation
- Next evaluation
- Status
Instructions on the form
- Register a provider only after sufficient evidence of evaluation (PR04, 5.3.4). Review at least annually and update when accreditation status changes.
Sign-off
- Reviewed by (Laboratory Manager)
Related templates
- Referral Laboratory Evaluation Checklist (PR04-F01)
- Consultant Evaluation Checklist (PR04-F02)
- Sample Referral Log (PR04-F05)
- Guide: ISO 15189 documentation checklist
Clause references are to ISO 15189:2022; check them against your licensed copy of the standard.