List of Critical Results (alert Values) template
A form in the Result Release and Critical Results procedure (PR14), mapped to ISO 15189:2022 clause 7.4.1. Fill it in whenever the task occurs. Used by the laboratory team.
FormISO 15189 · 7.4.1As needed
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Your LaboratoryList of Critical Results (alert Values) | YL-LAB-FRM-14-F03 v1.0
Form: List of Critical Results (alert Values)
| No. | Test / Analyte | Section | Units | Critical Low Value | Critical High Value | Paediatric Critical Low | Paediatric Critical High | Action Required | Comments / Exceptions |
|---|---|---|---|---|---|---|---|---|---|
| 1 | Glucose | Chemistry | mmol/L | < 2.5 | ≥ 25.0 | < 2.5 | ≥ 20.0 | Notify immediately | |
| 2 | Potassium | Chemistry | mmol/L | < 2.8 | ≥ 6.5 | < 2.5 | ≥ 6.5 | Notify immediately | |
| 3 | Sodium | Chemistry | mmol/L | < 120 | ≥ 160 | < 120 | ≥ 160 | Notify immediately | |
| 4 | Creatinine | Chemistry | µmol/L | ≥ 800 | ≥ 500 | Notify immediately | |||
| 5 | Haemoglobin | Haematology | g/dL | < 5.0 | ≥ 20.0 | < 5.0 | ≥ 20.0 | Notify immediately | |
| 6 | Platelet Count | Haematology | ×10⁹/L | < 20 | ≥ 1000 | < 20 | ≥ 1000 | Notify immediately | |
| 7 | WBC Count | Haematology | ×10⁹/L | < 2.0 | ≥ 30.0 | < 2.0 | ≥ 30.0 | Notify immediately | |
| 8 | INR / PT | Haematology | ≥ 5.0 | ≥ 5.0 | Notify immediately | ||||
| 9 | CSF WBC (Turbid/Any Cells) | Microbiology | cells/µL | Notify immediately | |||||
| 10 | Blood Culture — Positive | Microbiology | Positive | Positive | Notify immediately |
… 8 more rows continue on the next page
Sign-off
| Role | Name | Signature | Date |
|---|---|---|---|
| Completed by | |||
| Reviewed by |
Shaded cells are calculated automatically.
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What it records
- Test / Analyte
- Section
- Units
- Critical Low Value
- Critical High Value
- Paediatric Critical Low
- Paediatric Critical High
- Action Required
- Comments / Exceptions
Sign-off
- Completed by
- Reviewed by
Related templates
- List of Persons Authorized to Release Test Reports (PR14-F01)
- List of Persons Authorized to Receive Test Reports (PR14-F02)
- Critical Result Notification Log (PR14-F04)
- Guide: ISO 15189 documentation checklist
Clause references are to ISO 15189:2022; check them against your licensed copy of the standard.