List of Persons Authorized to Receive Test Reports 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
Calculated automaticallyRed = outside limits
Your LaboratoryList of Persons Authorized to Receive Test Reports | YL-LAB-FRM-14-F02 v1.0
Record: List of Persons Authorized to Receive Test Reports — October 2026
Release critical and urgent results only to persons on this list (PR14, 6.6.6). Verify identity before giving results by telephone, and record the call on the Communication Log (PR01-F06).
| No. | Name | Designation | Ward / clinic / facility | Telephone | Reports authorized | Identity check | Authorized by / date | Review date | |
|---|---|---|---|---|---|---|---|---|---|
| 1 | R. Naidoo | Medical Technologist | +27 11 555 0110 | staff1@yourlab.example | All results | Staff ID | 2026-10-01 | 2026-10-01 | |
| 2 | S. Dlamini | Senior Technologist | +27 11 555 0111 | staff2@yourlab.example | All results | Staff ID | 2026-10-08 | 2026-10-08 | |
| 3 | A. Mensah | Quality Officer | +27 11 555 0112 | staff3@yourlab.example | All results | Staff ID | 2026-10-15 | 2026-10-15 | |
| 4 | L. Banda | Lab Assistant | +27 11 555 0113 | staff4@yourlab.example | All results | Staff ID | 2026-10-22 | 2026-10-22 | |
| 5 | K. Otieno | Medical Technologist | +27 11 555 0114 | staff5@yourlab.example | All results | Staff ID | 2026-10-29 | 2026-10-29 | |
| 6 | T. Moyo | Senior Technologist | +27 11 555 0115 | staff6@yourlab.example | All results | Staff ID | 2026-11-05 | 2026-11-05 | |
| 7 | R. Naidoo | Quality Officer | +27 11 555 0116 | staff7@yourlab.example | All results | Staff ID | 2026-11-12 | 2026-11-12 | |
| 8 | S. Dlamini | Lab Assistant | +27 11 555 0117 | staff8@yourlab.example | All results | Staff ID | 2026-11-19 | 2026-11-19 |
Sign-off
| Role | Name | Signature | Date |
|---|---|---|---|
| Completed by | |||
| Reviewed by |
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
A4 landscape · first page · showing 8 of 8 rowsExactly as LabToolkit Pro prints it — with your logo and colours
What it records
- Name
- Designation
- Ward / clinic / facility
- Telephone
- Reports authorized
- Identity check
- Authorized by / date
- Review date
Instructions on the form
- Release critical and urgent results only to persons on this list (PR14, 6.6.6). Verify identity before giving results by telephone, and record the call on the Communication Log (PR01-F06).
Sign-off
- Completed by
- Reviewed by
Related templates
- List of Persons Authorized to Release Test Reports (PR14-F01)
- List of Critical Results (alert Values) (PR14-F03)
- 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.