2016 A Proficiency Testing Program for Office Laboratories

The right choice for proficiency testing.

aafp.org/pt

Order Information. . . . . . . . . . . . . . . . . . . . . 1

Continuing Education Information . . . . . . . . 1

POL Microscopy Atlas. . . . . . . . . . . . . . . . . 1

COLA Laboratory Director . . . . . . . . . . . . . .2

AAFP-PT Multiple Lab Discount. . . . . . . . . .2

Experience the AAFP. . . . . . . . . . . . . . . . . .2

Lab Partnership . . . . . . . . . . . . . . . . . . . . . .2

Order Form . . . . . . . . . . . . . . . . . . . . . . . 3-4

Analyte Index. . . . . . . . . . . . . . . . . . . . . . 5-8

Hematology . . . . . . . . . . . . . . . . . . . . . . . . .9

Chemistry . . . . . . . . . . . . . . . . . . . . . . 10-11

Immunology/Virology . . . . . . . . . . . . . . 11-12

Microbiology . . . . . . . . . . . . . . . . . . . . 12-13

Urinalysis/Waived/PPM. . . . . . . . . . . . . . 13

Shipping Dates . . . . . . . .outside back cover

Accurate lab results are crucial to patient care. You can rely on AAFP-Proficiency Testing to help you maintain laboratory excellence with minimal cost and effort.

For more than 25 years, AAFP-PT has provided Proficiency Testing for physicians office laboratories. A comprehensive program from a name you can trust. AAFP-PT is flexible and simple:

u Three shipments per year

u Technologically advanced, state-of-the-art online reporting and access system

u Full-service proficiency testing and a quality assurance program for CLIA-waived and PPM labs

u Excellent customer and technical service

u CME credit for physicians and laboratory personnel

u Cost savings and multiple-site discounts

u Combined proficiency testing and COLA accreditation

u Approved by CMS and COLA

PT Central Online Reporting SystemThis easy-to-follow reporting tool features:

u Results that can be quickly and easily submitted online (your online account will include your specific analytes and methods)

u Automatic email notice that your results have been submitted

u Access to labs’ evaluations and forms

u Receive an email notice when your evaluation is ready

Why Perform Laboratory Proficiency Testing? CLIA ’88 (Clinical Laboratory Improvement Amendments of 1988) requires that laboratory sites performing moderate or high complexity testing on human samples enroll in a proficiency testing program. Proficiency Testing (PT) is an external quality control process. It is the practice of testing unknown specimens from an outside source to assure quality laboratory testing results. Internal quality controls are performed daily in laboratories with known controls, but an external control program can provide an important comparison to determine the accuracy of your testing procedures.

CONTENTS

www.aafp.org/pt 1

Order InformationEnroll in AAFP-PT by November 1 to guarantee specimen availability for the following year!

However, AAFP-PT accepts enrollments throughout the year at a prorated cost for testing modules. The annual registration fee is not prorated and is not refundable.

To ensure specimen availability and to avoid delay in processing, please complete the AAFP-PT Order Form in its entirety. Once you’ve selected the modules your laboratory needs:

• Print clearly all the requested information on the AAFP-PT Order Form found at www.aafp.org/pt

• Place an X by the module(s) you are ordering

• Fax the Order Form to (913) 906-6079

• Or, mail it to AAFP-PT, 11400 Tomahawk Creek Parkway Leawood, Kansas, 66211-2672

An order form must accompany all purchase orders. If you need assistance in Module selection, contact one of our program coordinators at (800) 274-7911, option 2.

Binder/NotebooksA notebook or binder is a convenient way to organize all annual proficiency testing materials and records. All enrolled laboratories will receive full-color front and back cover pages and tabs suitable for insertion into the participant’s own view-style three-ring binder.

Changes and Additions to OrderAll changes must be submitted in writing by fax, mail, or email to AAFP-PT three weeks prior to an event shipping date. Any module may be added to an existing order depending on the shipping schedule, result due date, and material availability. A $25.00 shipping charge will be applied if a separate shipment is required. The module cost will be prorated according to the number of shipments remaining in the program year and the financially responsible party will be invoiced.

International ShippingInternational participants may incur additional shipping fees. Please contact AAFP-PT for a quote.

Refund/Cancellation PolicyModule cancellations must be received in writing six weeks prior to the event ship date to receive credit for that event. The annual registration fee is not prorated and is non-refundable. Facilities will be issued a credit for deleted modules based on the number of shipments remaining in the program year. Credits will be applied to the following year’s proficiency testing order. If no order is being placed for the next year, a refund check will be issued upon request at the end of the current program year.

Off-Schedule/Reinstatement TestingSubject to product availability, proficiency testing specimens are available throughout the program year. AAFP-PT provides reinstatement specimens for regulated analytes as required by CLIA regulations. Under normal circumstances, specimens can be shipped the same day or next day, with a seven to 10 day evaluation process once results are received (unless otherwise specified when the order is placed). AAFP-PT will report your reinstatement testing performance to CMS or COLA the same day you receive your evaluation. Price is per specimen.

Pre-paid orders only are accepted for off-schedule shipments. AAFP-PT will provide specimen handling instructions and simple to use result forms. For more information call (800) 274-7911, ext. 4146.

Submitting Results for Multiple Instruments or MethodsUnder CLIA’ 88 regulations, laboratories are only permitted to submit results for one instrument or method per analyte per testing event. Laboratories wishing to perform proficiency testing on additional methods or instruments as part of their in-house quality assurance program must notify AAFP-PT in advance. These laboratories must delay testing for the secondary methods until the event deadline is past. At that time, the laboratory will receive an email notification indicating a limited time period for performing testing and submitting results from additional instruments. The graded results for the additional instruments/methods will appear on the Evaluation Report, but will not be transmitted to accrediting agencies.

Continuing Education InformationYou can earn up to 12 hours of CME credits for your participation, review, and/or management of the AAFP-PT proficiency testing process in your office lab. To do so, you must also complete educational materials specifically developed for the physician office lab. The POL Insight is distributed to participants three times a year at no additional charge. AAFP-PT is approved as a Provider of continuing education programs in the clinical laboratory sciences by the ASCLS P.A.C.E.® Program. This is a benefit offered to all participants at no additional cost.

The educational material addresses technical, regulatory, and operational information of interest to the POL. Recent topics include:

• Educating Patients on Laboratory Testing

• Quality Assurance for the POL

• POCT in Family Medicine

• Pregnancy Testing in the POL

• Proficiency Testing & iQCP

• Urine Drug Screens

POL Microscopy Atlas, 4th EditionDeveloped by AAFP-PT—A must for the PPM LaboratoryThis unique product contains more than 150 photos of cellular elements, including urine sediments, vaginal wet preps, skin preps, nasal smears, stools for fecal leukocytes, stools for pinworms, peripheral bloods, fern test, and Gram stains. Each photo has a matching description and clinical associations. The Atlas also contains procedures for urine sediment and vaginal wet prep examinations and for peripheral blood smears, as well as the applicable CLIA regulations. Useful for training, continuing education, and as a benchtop reference. For more information about the POL Microscopy Atlas contact Cheryl Murray (800) 274-7911, ext. 4147 or cmurray@aafp.org. See ad on page 2.

• Product #730 (4th Edition) $99.95

2 2016 Proficiency Testing Program (800) 274-7911

COLA Laboratory Director – Online Program OnlyModule #504 — This online program is approved for physi-cians to meet CLIA’ 88 requirements for Laboratory Directors in a moderately complex Physician Office Laboratory. Course Modules include: Quality Control in the Clinical Laboratory, Part 1-3; OSHA Safety Requirements for the Medical Laboratory; CLIA’ 88 Requirements for the Physician Office Laboratory; Laboratory Personnel Requirements for the Physician Office Laboratory; and Practical Proficiency Testing.

AAFP-PT Plus – Multiple Lab DiscountGet more when you enroll more. When you enroll three or more laboratories, the benefits add up. Take advantage of consolidated billing, customized summary reports, and a record-keeping binder. You will also receive a discount on the POL Microscopy Atlas. For more information regarding AAFP-PT Plus, please call (800) 274-7911. All orders must be submitted together to receive the volume discount.

Experience the AAFP Program for New PhysiciansExperience the AAFP was created for new physician members. This AAFP program offers members in their first seven years following residency completion a sample of CME tools and networking opportunities at a reduced rate. New physicians are eligible for waiver of their PT program registration fees and a discounted price for the POL Atlas. NOTE: You must be a member of AAFP and in your first seven years post-residency to qualify for this program.

AAFP/COLA Lab PartnershipIn one complete package, AAFP offers its members the opportunity for education and fulfillment of regulatory requirements. You’ll realize significant savings on programs and services through the AAFP/COLA Lab partnership. Save your lab time and money with the following benefits:

• Waived registration fee for AAFP-PT participants

• Up to 15% discount

• COLA covers switching fees

• Group Lab Discount of $50 per facility when groups of three or more enroll with COLA

• 15% discount for AAFP members on COLA’s Lab University e-Learning courses and educational publications

• FREE e-Learning course on Quality Assurance

• 10% discount on COLA’s annual Physician Office Laboratory Symposium

• FREE enrollment in COLA Central

• More than 150 color photos

• Includes all PPM specimen types, plus blood cell identification and Gram stains

• Concise, easy-to-follow descriptions, clinical associations, and procedures

• Suitable for training and competency assessment

TO ORDER:www.aafp.org/microscopy

(800) 274-2237

AAFP’s THE POL MICROSCOPY ATLAS

ATLAS

4TH EDITION

AAFP PHYSICIAN’S OFFICE LABORATORY MICROSCOPY

3www.aafp.org/pt

2016 AAFP Proficiency Testing Order Form

HEMATOLOGYr 602 Hematocrit (spun) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$100r 603 Blood Cell Identification . . . . . . . . . . . . . . . . . . . . . . . . . . . $42r 604 Reticulocyte Count . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$216r 606 Hemocue WBC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $207r 610 Regular Hematology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $207r 611 QBC Hematology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$261r 613 Auto Diff I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $234r 614 Auto Diff II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $234r 621 Accumetrics VerifyNow Aspirin . . . . . . . . . . . . . . . . . . . . $228r 622 Accumetrics VerifyNow P2Y12 . . . . . . . . . . . . . . . . . . . . $228r 623 Accumetrics VerifyNow IIb/IIa . . . . . . . . . . . . . . . . . . . . . $228r 649 DAT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $171r 650 Blood Bank . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $372r 680 Coagulation – Plasma . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$159r 730 Sed Rate (ESR) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$150r 736 ABO/Rh Only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $270r 739 Sickle Cell Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$156r744 ITC Hemachron Protime (Citrated WB) . . . . . . . . . . . . . $252r 745 Auto Diff 5 (5-part Diff) . . . . . . . . . . . . . . . . . . . . . . . . . . . $297r 746 Auto Diff 6 (5-part Diff) . . . . . . . . . . . . . . . . . . . . . . . . . . . $297r 747 Auto Diff 7 (5-part Diff) . . . . . . . . . . . . . . . . . . . . . . . . . . . $297r 748 I-Stat Protime . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$231r 752 Auto Diff 8 (5-part Diff) . . . . . . . . . . . . . . . . . . . . . . . . . . . $297r763 CoaguChek XS Plus (2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . $141r 764 CoaguChek XS Plus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $225

IMMUNOLOGY / VIROLOGYr 643 ANA (latex) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$150r 644 H . pylori . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$135r 653 Rheumatoid Factor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$144r 654 Lyme Serology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $204r 655 Immunoproteins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$198r 671 Total IgE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$129r 673 Rubella . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$144r 674 Diagnostic Allergy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $306r 675 Infectious Mono . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$144r 678 Serum hCG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$144r 679 Syphilis Serology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$162r 683 ASO/CRP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$195r 684 CRP (2) (qual . and quad .) . . . . . . . . . . . . . . . . . . . . . . . . . .$135r 750 Viral Markers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $399r 751 Infectious Mono/EBV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$189r 753 Infectious Mono (Waived) . . . . . . . . . . . . . . . . . . . . . . . . . . .$75r 754 Infectious Mono/RF Combo . . . . . . . . . . . . . . . . . . . . . . . $228r 755 HIV Antigen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$351r 756 Viral Antibodies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$180r 757 Special Immunology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $141r 758 Mycoplasma Antibody . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$165r 759 Complete Immunology . . . . . . . . . . . . . . . . . . . . . . . . . . . $405r 760 ANA (Elisa) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $147r 761 hsCRP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $141r 762 HIV Antibody (Waived Methods) . . . . . . . . . . . . . . . . . . . .$153r 765 Allergen Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$135r 766 HIV Antibody . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $348r767 Hepatitis Markers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $387r 932 Hepatitis C Antibody (Waived Method) . . . . . . . . . . . . . $249r 931 Anti-CCP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $297

MICROBIOLOGYr 661 Urine Colony Count . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $171r 665 Strep Antigen (2 Challenges) . . . . . . . . . . . . . . . . . . . . . . $90r 668 Gram Stain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$144r 691 Strep Antigen (5 Challenges) . . . . . . . . . . . . . . . . . . . . . . $174r 699 Strep Antigen (1 Challenge) . . . . . . . . . . . . . . . . . . . . . . . . $84r 768 MRSA/VRE/Add-on (2) . . . . . . . . . . . . . . . . . . . . . . . . . . . $198r 769 Campylobacter Antigen . . . . . . . . . . . . . . . . . . . . . . . . . . . $108r 770 Viral Antigen Detection . . . . . . . . . . . . . . . . . . . . . . . . . . . .$291r 771 Affirm VP Package . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$351r 772 Dermatophyte Culture/Screen . . . . . . . . . . . . . . . . . . . . . .$231r 773 Candida Detection Package . . . . . . . . . . . . . . . . . . . . . . . $279r 774 GenProbe GC/Chlamydia . . . . . . . . . . . . . . . . . . . . . . . . . $354r 775 Urine Culture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $255 r776 Throat Culture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $255r 777 GC Culture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $255r 778 Urine and Throat Cultures . . . . . . . . . . . . . . . . . . . . . . . . $255r 779 Urine and Genital Cultures . . . . . . . . . . . . . . . . . . . . . . . . $255r 780 Throat and Genital Cultures . . . . . . . . . . . . . . . . . . . . . . . $255r 781 Urine, Throat and Genital Cultures . . . . . . . . . . . . . . . . . $255r 782 Complete Bacteriology . . . . . . . . . . . . . . . . . . . . . . . . . . . $273r 783 Group A Strep/Add-On (2 ) . . . . . . . . . . . . . . . . . . . . . . . . . $36r 784 Pres ID/Colony Count – Urine . . . . . . . . . . . . . . . . . . . . . $273r 785 Pres ID/Colony Ct – Urine/ Strep Combo . . . . . . . . . . . $273r 786 Parasitology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $270r 787 Giardia Antigen Detection . . . . . . . . . . . . . . . . . . . . . . . . . .$123r 788 Acid Fast Smear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$168r 789 Bacterial Antigen Detection . . . . . . . . . . . . . . . . . . . . . . . $285r 790 Urine Susceptibility Add-On . . . . . . . . . . . . . . . . . . . . . . . . .$27 (*790 can only be ordered in conjunction with Modules 661, 784-785)r 792 Viral Antigen Detection (Waived) . . . . . . . . . . . . . . . . . . .$132r 793 Shiga Toxin 1 & 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $189r 794 GC & Chlamydia Ag Det . (5) . . . . . . . . . . . . . . . . . . . . . . $309r 795 GC & Chlamydia Ag Det . (2) . . . . . . . . . . . . . . . . . . . . . . . .$108r 796 GC Culture/Add-on (2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$108 (*796 can only be ordered in conjunction with other culture Modules)r 797 Viral Antigen Detection II . . . . . . . . . . . . . . . . . . . . . . . . . .$291r 798 Viral Antigen Detection (ROT) . . . . . . . . . . . . . . . . . . . . . .$291r 971 Giardia/Cryptosporidium Antigen (5) . . . . . . . . . . . . . . . $252r 972 Giardia/Cryptosporidium Antigen (2) . . . . . . . . . . . . . . . . $147

URINALYSIS / WAIVED / PPMr 600 Cholestech LDX/CardioChek Package . . . . . . . . . . . . . .$153r 601 Waived/PPM Tests Custom 1 . . . . . . . . . . . . . . . . . . . . . . .$195r602 Hematocrit (2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$100r 608 Hemocue Glucose/Hgb . . . . . . . . . . . . . . . . . . . . . . . . . . . .$129r 609 Waived/PPM Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $297r 637 KOH – Glass Slides (Skin, Hair, or Nail) . . . . . . . . . . . . . .$168r 638 Urine Sediment Microscopy . . . . . . . . . . . . . . . . . . . . . . . . $42r 639 Complete Urinalysis Pkg . . . . . . . . . . . . . . . . . . . . . . . . . . .$126r 640 Urinalysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $81r 641 Clinical Microscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$150r 642 Urinalysis/hCG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $84r 647 UA/hCG/Fecal Occult Blood . . . . . . . . . . . . . . . . . . . . . . . $99r 791 Fecal Occult Blood Add-on . . . . . . . . . . . . . . . . . . . . . . . . . $30 (*791 can only be ordered in conjunction with Modules 639, 640 and 642)

CHEMISTRYr 612 MultiChem 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $243r 616 MultiChem 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $270r617 MultiChem 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $297r 618 MultiChem 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $324

r 619 MultiChem 21+ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$381r 645 Fetal Membrane Rupture . . . . . . . . . . . . . . . . . . . . . . . . . $285r 651 Fructosamine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$144r 652 CSF and Bloody Fluid Analysis . . . . . . . . . . . . . . . . . . . . $283r 662 Neonatal Bilirubin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$186r 663 Neonatal Bilirubin (2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$126r 664 Whole Blood Glucose (2) . . . . . . . . . . . . . . . . . . . . . . . . . .$129r 666 Glycohemoglobin, Affinion . . . . . . . . . . . . . . . . . . . . . . . . .$183r 667 PSA Add on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $35r 669 Whole Blood Glucose . . . . . . . . . . . . . . . . . . . . . . . . . . . . $246r 672 Glycohemoglobin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$183r 676 Endocrinology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$195r 677 Thyroid Antibodies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $276r 685 Special Chemistry II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$153r 686 Special Chemistry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $222r 687 Ammonia (2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$168r 688 SHGBG and Testosterone . . . . . . . . . . . . . . . . . . . . . . . . . $396r 700 i-Stat® Chemistry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$261r 701 Troponin T . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$213r 702 Blood Gases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $384r 703 Urine Drug Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $222r 705 Urine Microalbumin & Creatinine . . . . . . . . . . . . . . . . . . . $141r 708 Tumor Markers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $396r 709 Blood Lead . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $462r 711 BNP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $246r 712 Apolipoproteins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $147r 713 Urine Drug Screen (50 ml) . . . . . . . . . . . . . . . . . . . . . . . . $285r 714 Complete Cardiac Markers . . . . . . . . . . . . . . . . . . . . . . . . $243r 715 Basic Cardiac Markers . . . . . . . . . . . . . . . . . . . . . . . . . . . $207r 716 Blood Lead (Waived) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$198r 717 Abaxis Piccolo® (Waived) . . . . . . . . . . . . . . . . . . . . . . . . . .$183r 718 Abaxis Piccolo® (Non-Waived) . . . . . . . . . . . . . . . . . . . . . .$261r 719 Quantitative HCG (Serum) . . . . . . . . . . . . . . . . . . . . . . . . .$135r 720 Cardiac Markers I (2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$180r 721 i-Stat® Chemistry & Blood Gas Combo . . . . . . . . . . . . . $270r 722 i-Stat® Chemistry (Waived) . . . . . . . . . . . . . . . . . . . . . . . . . $174r 723 i-Stat® Blood Gases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $234r724 Urine hCG (non-waived) . . . . . . . . . . . . . . . . . . . . . . . . . . .$144 r 726 NTproBNP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $252r 727 Blood Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $287r 728 Urine Chemistry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $264r 740 D-Dimer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$144r915 Body Fluid pH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $204r919 Body Fluid Cell Count . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $177r 950 Post Vasectomy Sperm Analysis . . . . . . . . . . . . . . . . . . $246

SUPPLIES / SUBSCRIPTIONSr 503 COLA’s Lab Facts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$75r 504 COLA’s Laboratory Director . . . . . . . . . . . . . . . . . . . . . . . $450r 730 POL Microscopy Atlas . . . . . . . . . . . . . . . . . . . . . . . . $99 .95**** Plus Shipping and Handling+Payment due at time of order on Atlas Orders.

MODULE TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . $______________

ANNUAL REGISTRATION FEEr Experience the AAFP (see page 2) . . . . . . . . . . . . . . . $___________N/Cr COLA MEMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $___________N/Cr REGISTRATION FEE . . . . . . . . . . . . . . . . . . . . . . . . . . $__________75 .00(Note registration fees are nonrefundable)TOTAL DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $______________

continued on the back side

Retain a photocopy of this form for your records.

ORDER INFORMATIONEnroll in AAFP-PT by November 1, 2015, to guarantee specimen availability for the following year! However, AAFP-PT accepts enrollments throughout the year at a prorated cost for testing modules. The annual registration fee is not prorated and is not refundable.

To ensure specimen availability and to avoid delay in processing, please complete the AAFP-PT Order Form in its entirety. Once you’ve selected the modules your laboratory needs:

• Print clearly all the requested information on the AAFP-PT Order Form found at www.aafp.org/pt

• Place an X by the module(s) you are ordering

• Fax the Order Form to (913) 906-6079

• Or, mail it to AAFP-PT, 11400 Tomahawk Creek Parkway, Leawood, Kansas, 66211-2672

An order form must accompany all purchase orders. If you need assistance in Module selection, contact one of our program coordinators at (800) 274-7911, option 2.

ORDER CONFIRMATION, WELCOME PACKS, AND SETUP CONFIRMATIONSYou will receive an email confirmation when your order is processed. This confirmation will be sent to the email address provided at the time of enrollment. Please notify AAFP-PT if your email address changes, or if there are additional addresses that should receive Proficiency Testing communications.

Method Request Forms — A Method Request Form is emailed or faxed to all new program enrollees upon enrollment. This customized form includes the ordered modules. You are asked to complete this form by providing the instrument/kit to be used in testing and the analytes tested in each module. It is critical that this information be complete and accurate in order to ensure that you receive the appropriate specimens and are graded with the correct peer groups. Please return promptly to AAFP-PT. After your information has been processed by AAFP-PT, you will receive a Welcome Pack to confirm your enrollment.

Welcome Pack — New enrollees will receive a Welcome Pack four to six weeks after return of their Method Request Forms. The Welcome Pack includes PT Central log-in instructions and a Set-up Confirmation. The Set-up Confirmation describes your current reporting set up. Please review carefully for an accurate listing of all analytes and testing methods. Indicate any changes to your testing menu (analytes added or deleted) or any changes in instrumentation or kits and send the changes promptly to AAFP-PT.

Set-up Confirmation (Current participants) — By mid-January, current enrollees may log in to PT Central to print and review their set-up confirmation. This form should be reviewed prior to each event to ensure that the testing menu is correct and that the current instruments/methods are shown. Enrollees should also verify that contact and shipping information is correct.

Changes and Additions to OrderAll changes must be submitted in writing by fax, mail, or email to AAFP-PT three weeks prior to an event shipping date. Any module may be added to an existing order depending on the shipping schedule, result due date, and material availability. A $25.00 shipping charge will be applied if a separate shipment is required. The module cost will be prorated according to the number of shipments remaining in the program year and the financially responsible party will be invoiced.

Refund/Cancellation PolicyModule cancellations must be received in writing six weeks prior to the event ship date to receive credit for that event. The annual registration fee is not prorated and is non-refundable. Facilities will be issued a credit for deleted modules based on the number of shipments remaining in the program year. Credits will be applied to the following year’s proficiency testing order. If no order is being placed for the next year, a refund check will be issued upon request at the end of the current program year.

Off-Schedule/Reinstatement TestingSubject to product availability, proficiency testing specimens are available throughout the program year. AAFP-PT provides reinstatement specimens for regulated analytes as required by CLIA regulations. Under normal circumstances, specimens can be shipped the same day or next day, with a seven to 10 day evaluation process once results are received (unless otherwise specified when the order is placed). AAFP-PT will report your reinstatement testing performance to CMS or COLA the same day you receive your evaluation. Price is per specimen. Pre-paid orders only are accepted for off schedule shipments. AAFP-PT will provide specimen handling instructions and simple to use result forms. For more information call (800) 274-7911, ext. 4146.

Accreditation StatementsThis enduring material activity, AAFP-PT POL Insight, has been reviewed and is acceptable for up to 9 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins March 2, 2015. Term of approval is for one year from this date with the option of yearly renewal. Each issue is approved for 3 Prescribed credits. Credits may be claimed for one year from the date of each issue. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The AAFP is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Academy of Family Physicians designates this enduring material activity for a maximum of 9 AMA PRA Category 1 credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Credit may be claimed for one year from the date of this event.

AAFP-PT is approved as a Provider of continuing education programs in the clinical laboratory sciences by the ASCLS P.A.C.E.® Program. AAFP-PT is also an approved provider for California clinical laboratory licensees under the P.A.C.E.® Program. The level of instruction for this event is Basic. This event is worth 4 P.A.C.E.® Contact Hours.

ORDER INFORMATION

rAAFP-PT Plus rNEW COLA Member

How did you hear about us?

______________________________________________________________________________________________________________

_______________________________________________________________________________________________________AAFP-PT #

_______________________________________________________________________________________________________Practice Name

_______________________________________________________________________________________________________Medical Director (please print as listed on CLIA certificate)

Is the Medical Director or other staff physician a member of the AAFP? rYes — AAFP Member # ________________________ r No

Number of Physicians in Practice __________________ Number of Family Physicians in Practice __________________

__________________________________________________________________________________________________ Street Address

_____________________________________________________________________________________________________________ City, State, Zip

_____________________________________________________________________________________________________________ Attention

_____________________________________________________________________________________________________________ Phone Number

_____________________________________________________________________________________________________________ Fax Number

_____________________________________________________________________________________________________________ Email

_____________________________________________________________________________________________________________ Consultant Name/ Distributor Company Name (if applicable)

_____________________________________________________________________________________________________________ Address

_____________________________________________________________________________________________________________ City, State, Zip

_____________________________________________________________________________________________________________ Phone Number

_____________________________________________________________________________________________________________ Fax Number

_____________________________________________________________________________________________________________ Email

_____________________________________________________________________________________________________________ Sales Rep Name

_____________________________________________________________________________________________________________ Distributor P.O.#

PAYMENT INFORMATION — PAYMENT TERMS: NET 30 DAYS

rInvoice rCheck Enclosed (Payable to AAFP) rMC/VISA/DISCOVER/AMEX

PO # ________________________________________________________________________________________________________

Credit card # _________________________________________________________________________________________________

Name _________________________________________________________________ Exp. Date __________________________

Signature ____________________________________________________________________________________________________

REGULATORY INFORMATION

CLIA ID# ___ ___ D ___ ___ ___ ___ ___ ___ ___

CLIA Classification: rWaived rCompliance rPPM rAccredited

COLA # ________________________________________________________________ rJCAHO Affliated

Other Accrediting Agency # ____________________________________________________________________________________

State Agency (or region, if applicable) # _________________________________________________________________________

2016 SHIP DATES: MARCH 7, JUNE 6, AND OCTOBER 3

Products ordered may contain pathogenic materials. AAFP-PT is not liable or responsible for the handling, storage, use, and disposal of the product upon receipt by your office.

Order before November 1, 2015 to guarantee specimen availability.

PLEASE PRINT ALL REQUESTED INFORMATION ON THE ORDER FORM AND MAIL OR FAX TO:

AAFP-PT, 11400 Tomahawk Creek Pkwy, Leawood, KS 66211-2680FAX: (913) 906-6079 • PHONE: (800) 274-7911

5www.aafp.org/pt

TEST . . . . . . . . . . . . . . . . . . . . . . . Page MODULE #

6-monoacetylmorphine. . . . . . . . . . . . . .11 703, 713

IIb/IIIa . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 623

ABO Group . . . . . . . . . . . . . . . . . . . . . . .9 650, 736

Acetaminophen . . . . . . . . . . . . . . . . . 10, 11 612, 616, 617, 618, 619, 703, 713

Acetone . . . . . . . . . . . . . . . . . . . . . . . . . .11 727

Acid Fast Smear . . . . . . . . . . . . . . . . . 13 788

Adenovirus . . . . . . . . . . . . . . . . . . . . . . 12 797

AFP (Alpha fetoprotein). . . . . . . . . . . 10 708, 612, 616, 617, 618, 619

Albumin . . . . . . . . . . . . . . . . . . . . . . . 10, 11 612, 616, 617, 618, 619, 717, 718

Alcohol, Blood . . . . . . . . . . . . . . . . . . . .11 727

Alkaline Phosphatase . . . . . . . . . . 10, 11 612, 616, 617, 618, 619, 717, 718

Allergen Testing . . . . . . . . . . . . . . . . . . . .11 765

Allergen Specific IgE. . . . . . . . . . . . . . . .11 674

Alpha-1 Antitrypsin . . . . . . . . . . . . . . . .11 655

ALT/SGPT . . . . . . . . . . . . . . . . . . 10, 11, 13 600, 612, 616, 617, 618, 619, 717, 718

Amikacin . . . . . . . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619

Amphetamines (urine) . . . . . . . . . . . . . .11 703, 713

Amylase . . . . . . . . . . . . . . . . . . . . . . . 10, 11 612, 616, 617, 618, 619, 717, 718

Ammonia. . . . . . . . . . . . . . . . . . . . . . . . . 10 687

Anti-CCP . . . . . . . . . . . . . . . . . . . . . . . . . 12 931

ANA (Anti-Nuclear Antibody) (latex, qual. & quant.) . . . . . . . . . . . 11, 12 643, 757

ANA (Anti-Nuclear Antibody) (ELISA) . . . . . . . . . . . . . . . . . . . . . . . . . . 12 760

Anion Gap. . . . . . . . . . . . . . . . . . . . . 10, 13 721, 722

Antibody Detection, Direct (DAT) . .9 649

Antibody Detection – Blood Bank . .9 650

Antibody Identification – Blood Bank . . . . . . . . . . . . . . . . . . . . . . .9 650

ANTI-DNA . . . . . . . . . . . . . . . . . . . . . . . . 12 757

ANTI-HAV . . . . . . . . . . . . . . . . . . . . . . 11, 12 750, 767

ANTI-HBc . . . . . . . . . . . . . . . . . . . . . . 11, 12 750, 767

ANTI-RNP . . . . . . . . . . . . . . . . . . . . . . . . 12 757

ANTI-SM . . . . . . . . . . . . . . . . . . . . . . . . . 12 757

Apolipoprotein A1. . . . . . . . . . . . . . . . . . .11 712

Apolipoprotein B . . . . . . . . . . . . . . . . . . .11 712

Apolipoprotein C . . . . . . . . . . . . . . . . . . .11 712

Apolipoprotein E . . . . . . . . . . . . . . . . . . .11 712

APTT . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 680

ASO (Anti-Streptolysin O) (qual. & quant) . . . . . . . . . . . . . . . . . 11, 12 683, 759

Aspirin . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 621

AST/SGOT. . . . . . . . . . . . . . . . . . 10, 11, 13 600, 612, 616, 617, 618, 619, 717, 718

b-2 Microglobulin. . . . . . . . . . . . . . . . . . .11 708

Barbiturates (urine) . . . . . . . . . . . . . . . . .11 703, 713

BEecf . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 721, 723

Benzodiazepines (urine). . . . . . . . . . . . .11 703, 713

Bilirubin, Conjugated . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619

Bilirubin, Unconjugated . . . . . . . . . . . . 10 612, 616, 617, 618, 619

Bilirubin, Direct. . . . . . . . . . . . . . . . . . 10, 11 612, 616, 617, 618, 619, 718

Bilirubin, Neonatal . . . . . . . . . . . . . . . 10 662, 663

Bilirubin, Total . . . . . . . . . . . . . . . . . 10, 11 612, 616, 617, 618, 619, 717, 718

Blood Cell Identification . . . . . . . . . .9 603, 610

Blood Gases . . . . . . . . . . . . . . . . . . . 10, 11 702, 721, 723

Blood Lead . . . . . . . . . . . . . . . . . . . . . . .11 709

Blood Lead (Waived) . . . . . . . . . . . . 11, 13 716

BNP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 711

Body Fluid Analysis. . . . . . . . . . . . . . . . 10 652

Body Fluid Cell Count. . . . . . . . . . . . . . 10 919

Body Fluid PH . . . . . . . . . . . . . . . . . . . . 10 915

BUN (Blood Urea Nitrogen) . . . . . 10, 11 612, 616, 617, 618, 619, 700, 717, 718

Buprenorphine . . . . . . . . . . . . . . . . . . . . .11 703, 713

C. difficile Antigen . . . . . . . . . . . . . . . 13 789

C-Peptide . . . . . . . . . . . . . . . . . . . . . . . . 10 685

C3 (Complement C3). . . . . . . . . . . . . .11 655

C4 (Complement C4) . . . . . . . . . . . . . .11 655

CA 125 . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 708

CA 15-3 . . . . . . . . . . . . . . . . . . . . . . . . . . .11 708

CA 19-9 . . . . . . . . . . . . . . . . . . . . . . . . . . .11 708

CA 27/29. . . . . . . . . . . . . . . . . . . . . . . . . .11 708

Calcium, total . . . . . . . . . . . . . . . . . . 10, 11 612, 616, 617, 618, 619, 717, 718

Calcium, ionized . . . . . . . . . . . . . . . . 10, 11 702, 721, 722

Campylobacter Antigen . . . . . . . . . . 12 769

Candida species by Affirm® VP. . . . 12 771, 773

Candida Antigen Detection . . . . . . . 12 771, 773

Candida Culture . . . . . . . . . . . . . . . . . 12 773

Cannabinoids (THC) (urine). . . . . . . . . .11 703, 713

Cardiac Markers . . . . . . . . . . . . . . . . . . .11 714, 715, 720

Carbamazepine . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619

CBC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

CEA . . . . . . . . . . . . . . . . . . . . . . . . . . . 10, 11 686, 708

Chlamydia Antigen Detection . . . . . 13 789

ANALYTE INDEX – All regulated analytes are in RED and are provided at 5 challenges per shipment.

6 2016 Proficiency Testing Program (800) 274-7911

Chlamydia by DNA Probe . . . . . . . . . 12 774

Chloride . . . . . . . . . . . . . . . . . . . . . . . 10, 11 612, 616, 617, 618, 619, 700, 717, 718, 722

Cholesterol, Total . . . . . . . . . . . 10, 11, 13 600, 612, 616, 617, 618, 619, 717, 718

Cholesterol, HDL . . . . . . . . . . . . 10, 11, 13 612, 616, 617, 618, 619, 600, 717, 718

CK (Creatine Kinase) . . . . . . . . . . . 10, 11 612, 616, 617, 618, 619, 660, 718

CK-MB. . . . . . . . . . . . . . . . . . . . . . . . . . . .11 714, 715

Clinical Microscopy . . . . . . . . . . . . . . . . 13 609, 639, 641

CMV (Cytomegalovirus) Antibody . . . . . . . . . . . . . . . . . . . . . . . . . 12 756

CO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . 10, 11

612, 616, 617, 618, 619, 700, 717, 718, 721, 722, 723

Cocaine Metabolites (urine). . . . . . . . . .11 703, 713

Cotinine. . . . . . . . . . . . . . . . . . . . . . . . . . .11 703, 713

Colony Count, Urine . . . . . . . . . . . . 12, 13 661, 784, 785

Compatibility Testing . . . . . . . . . . . . . .9 650

Cortisol. . . . . . . . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619, 676

Creatinine . . . . . . . . . . . . . . . . . . . . . 10, 11 612, 616, 617, 618, 619, 700, 717, 718, 722

Creatinine (urine) . . . . . . . . . . . . . . . . . . .11 705, 728

CRP (C-Reactive Protein) (qual. & quant) . . . . . . . . . . . . . . . . . . . . .11 683, 684

CRP, high sensitivity . . . . . . . . . . . . . . . 12 761

Cryptosporidium Antigen . . . . . . . . . . . 13 971, 972

CSF Analysis . . . . . . . . . . . . . . . . . . . . . 10 652

Culture, Throat. . . . . . . . . . . . . . . . 12, 13 776, 778, 780, 781, 782

Culture, Genital Add-on . . . . . . . . . . . 12 796

Culture, Genital . . . . . . . . . . . . . . . . . . 12 777, 779, 780, 781, 782

Cultures, Miscellaneous (Blood, CSF, Eye, Ear, Skin, Sputum, Stool, Wound) . . . . . . . . . . . . . . . . . . . 13 782

Cultures Urine Presumptive ID . 12, 13 784, 785

Culture, Urine . . . . . . . . . . . . . . . . . . . . 13 775, 778, 779, 781, 782

D-Dimer . . . . . . . . . . . . . . . . . . . . . . . . . . .11 714, 740

Dermatophyte Culture . . . . . . . . . . . . 12 772

Dermatophyte Screen . . . . . . . . . . . . . . 12 772

DHEAS (DHEA Sulfate). . . . . . . . . . . . . 10 686

Differential, Automated QBC . . . . . . .9 611

Differential, Automated 1-3-part . . . .9 613, 614

Differential, Automated 5-part. . . . . .9 745, 746, 747, 752

Differential, Manual . . . . . . . . . . . . . . .9 603, 610

Digoxin . . . . . . . . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619

Drug Screen (urine). . . . . . . . . . . . . . . . .11 703, 713

EBV (Epstein-Barr Virus) Antibody . . . . . . . . . . . . . . . . . . . . . . . . . 12 756

EBV Mononucleosis . . . . . . . . . . . . . . . .11 751

EDDP. . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 703, 713

Erythrocyte Sedimentation Rate (ESR) . . . . . . . . . . . . . . . . . . . . . . . .9 730

Estradiol . . . . . . . . . . . . . . . . . . . . . . . . . 10 686

Estriol. . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 686

Ethanol (urine) . . . . . . . . . . . . . . . . . . . . .11 703, 713

Ethosuximide . . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619

Ecstasy (see MDMA)

Fecal Occult Blood . . . . . . . . . . . . . . . . 13 609, 791

Fern Testing . . . . . . . . . . . . . . . . . . . . . . 13 609, 639, 641

Ferritin . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 686

Fibrinogen . . . . . . . . . . . . . . . . . . . . . . . .9 680

Folate. . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 686

Fructosamine . . . . . . . . . . . . . . . . . . . . . 10 651

FSH (Follicle Stimulating Hormone) . . 10 686

Gardnerella vaginalis by Affirm® VP . . . . . . . . . . . . . . . . . . . . . . . 12 771

GC by DNA Probe . . . . . . . . . . . . . 12, 13 774, 794, 795

Gentamicin . . . . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619

GGT . . . . . . . . . . . . . . . . . . . . . . . . . . . 10, 11 612, 616, 617, 618, 619, 717, 718

Giardia Antigen Detection . . . . . . . . . . 13 787, 971, 972

Glucose . . . . . . . . . . . . . . . . . . . . 10, 11, 13 600, 612, 616, 617, 618, 619, 700, 717, 718, 721, 722

Glucose, whole blood . . . . . . . . . . . 10, 13 669, 609, 664

Glucose, HemoCue whole blood . . . . 13 608

Glycohemoglobin . . . . . . . . . . . . . . 10, 13 666, 672

Gram Stain (includes morphology) . . 12 668

Group B Strep Antigen . . . . . . . . . . . 13 789

HCO3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 723

H. pylori . . . . . . . . . . . . . . . . . . . . . . . . . . .11 644

HAV (Antibody) . . . . . . . . . . . . . . . . . 11, 12 750, 767

HbeAg. . . . . . . . . . . . . . . . . . . . . . . . . 11, 12 750, 767

HbsAg . . . . . . . . . . . . . . . . . . . . . . . . . 11, 12 750, 767

hCG (Quantitative, serum) . . . . . . 10, 11612, 616, 617, 618, 619, 676, 719

hCG (Qualitative, serum) . . . . . . . 11, 12678, 759

hCG (Urine) . . . . . . . . . . . . . . . . . . . . . . 13609, 639, 642, 724

HCV . . . . . . . . . . . . . . . . . . . . . . . . . . . 11, 12 750, 767

Hematocrit . . . . . . . . . . . . . . . . . . . . 9, 13 609, 610, 611, 613, 614, 700, 721, 722, 745, 746, 747, 752

Hematocrit (spun) . . . . . . . . . . . . . . 9, 13 602, 609

Hemoglobin . . . . . . . . . . . . . . . . . . . 9, 13 602, 609, 610, 611, 613, 614, 620, 700, 721, 722, 745, 746, 747, 752

All CLIA regulated analytes are provided at 5 challenges per event.

Non-regulated analytes are provided at 1-2 challenges per event.

7www.aafp.org/pt

Hemoglobin — HemoCue. . . . . . . . . . . 13 608, 609

Hepatitis . . . . . . . . . . . . . . . . . . . . . . . 11, 12 750, 767, 932

HSV (Herpes Simplex Virus) Antibody . . . . . . . . . . . . . . . . . . . . . . . . . 12 756

HIV Antibody . . . . . . . . . . . . . . . . . . . . . 12 750, 762, 766

HIV Antigen. . . . . . . . . . . . . . . . . . . . . . . .11 755

Homocysteine . . . . . . . . . . . . . . . . . . . . 10 686

IgA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 655

IgE (Quant and Semi-Quant) . . . . . . .11 671, 674

IgG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 655

IgM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 655

Infectious Mononucleosis. . . . 11, 12, 13 609, 675, 751, 753, 754, 759

Influenza A . . . . . . . . . . . . . . . . . . . 12, 13 770, 792, 797, 798

Influenza A/B . . . . . . . . . . . . . . . . . 12, 13 770, 792, 797, 798

Influenza B . . . . . . . . . . . . . . . . . . . 12, 13 770, 792, 797, 798

INR (International Normalized Ratio) . . . . .9 680, 744, 748, 763, 764

Insulin . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 685

Ionized Calcium . . . . . . . . . . . . . . . . . . . 10 702, 721, 722, 723

Iron . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619

i-STAT® Blood Gases. . . . . . . . . . . . . . . 10 721, 723

i-STAT® Chemistry . . . . . . . . . . . . . . . . . 10 700, 721, 722, 723

i-STAT® Protime . . . . . . . . . . . . . . . . . . . .9 748

KOH (glass slides–hair/skin/nails). . . 13 637

Lactic Acid . . . . . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619

Lactate. . . . . . . . . . . . . . . . . . . . . . . . . . . 10 723

LDH . . . . . . . . . . . . . . . . . . . . . . . . . . . 10, 11 612, 616, 617, 618, 619, 718

LDL (Calculated and Direct) . . . . . . 10, 11 612, 616, 617, 618, 619, 717, 718

LH (Lutenizing Hormone) . . . . . . . . . . . 10 686

Lipase . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619

Lithium . . . . . . . . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619

Lp(a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 712

LSD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 703, 713

Lyme Serology . . . . . . . . . . . . . . . . . . . . .11 654

Magnesium . . . . . . . . . . . . . . . . . . . . 10, 11 612, 616, 617, 618, 619, 718

MDMA (Ecstasy) . . . . . . . . . . . . . . . . . . .11 703, 713

Membranes, Fetal Rupture. . . . . . . . . . 10 645

Methadone (urine). . . . . . . . . . . . . . . . . .11 703, 713

Methamphetamine. . . . . . . . . . . . . . . . . .11 703, 713

Methaqualone (urine) . . . . . . . . . . . . . . .11 703, 713

Microalbumin (urine) . . . . . . . . . . . . . . . .11 705

MRSA (Add-on). . . . . . . . . . . . . . . . . . . 12 768

Mycoplasma Antibody . . . . . . . . . . . . . 12 758

Myoglobin . . . . . . . . . . . . . . . . . . . . . . . . .11 714, 715, 720

N-acetyl Procainamide (NAPA) . . . . 10 612, 616, 617, 618, 619

Nasal Smear . . . . . . . . . . . . . . . . . . . . . 13 609, 639, 641

Neisseria gonorrhoeae (GC) Culture, Add-on . . . . . . . . . . . . . . . . . . 12 796

Neisseria gonorrhoeae (GC) by DNA Probe . . . . . . . . . . . . . . . . . 12, 13 774, 794, 795

NTproBNP. . . . . . . . . . . . . . . . . . . . . . . . .11 726

Opiates (urine) . . . . . . . . . . . . . . . . . . . . .11 703, 713

Osmolality . . . . . . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619

Oxycodone . . . . . . . . . . . . . . . . . . . . . . . .11 703, 713

PAP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 686

Paramyxovirus IgG . . . . . . . . . . . . . . . . 12 756

Paramyxovirus IgM . . . . . . . . . . . . . . . . 12 756

Parasitology . . . . . . . . . . . . . . . . . . . . . 13 786

P2Y12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 622

pCO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 702, 721, 723

PCP (urine) . . . . . . . . . . . . . . . . . . . . . . . .11 703, 713

pH . . . . . . . . . . . . . . . . . . . . . . . . . . . 10, 11 702, 703, 713, 721, 723, 915

Phenobarbital. . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619

Phenylalanine. . . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619

Phenytoin. . . . . . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619

Phosphorous . . . . . . . . . . . . . . . . . . . 10, 11 612, 616, 617, 618, 619, 717, 718

Pinworm Prep. . . . . . . . . . . . . . . . . . . . . 13 609, 639, 641

Platelet Count . . . . . . . . . . . . . . . . . . . .9 610, 611, 613, 614, 745, 746, 747, 752

Platelet Function Tests . . . . . . . . . . . . . .9 621, 622, 623

pO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

702, 721, 723

Potassium . . . . . . . . . . . . . . . . . . . . . 10, 11 612, 616, 617, 618, 619, 700, 717, 718, 721, 722

Prealbumin . . . . . . . . . . . . . . . . . . . . . . 10 686

Primidone . . . . . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619

Procainamide . . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619

Progesterone . . . . . . . . . . . . . . . . . . . . . 10 686

Prolactin . . . . . . . . . . . . . . . . . . . . . . . . . 10 686

Propoxyphene (urine) . . . . . . . . . . . . . . .11 703, 713

Protime/INR . . . . . . . . . . . . . . . . . . . . . .9 680, 744, 748, 763, 764

PSA, Total . . . . . . . . . . . . . . . . . . . . . . 10, 11 667, 686, 708

PSA, Free . . . . . . . . . . . . . . . . . . . . . . . . .11 708

PTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 685

Quinidine . . . . . . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619

RBC (Red Blood Cell Count) . . . . . . .9 610, 611, 613, 614, 745, 746, 747, 752

Reticulocyte Count . . . . . . . . . . . . . . . . .9 604

Rh Factor . . . . . . . . . . . . . . . . . . . . . . . . .9 650, 736

Rheumatoid Factor (qual. & quant) . . . . . . . . . . . . . . . . . 11, 12 653, 754, 759

Rotavirus Antigen Detection . . . . . . 12 770, 797, 798

RSV (Respiratory Syncytial Virus) Antigen Detection . . . . . . . . . . . . . . 11, 13 770, 792, 797, 798

Rubella Antibody . . . . . . . . . . . . . . . . . 12 756

Rubella (qual. & quant) . . . . . . . . . 11, 12 673, 759

Rubeola Antibody . . . . . . . . . . . . . . . . . 12 756

Salicylate. . . . . . . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619

Sedimentation Rate (ESR) . . . . . . . . . . .9 730

Sex Hormone Binding Globulin (SHBG) . . . . . . . . . . . . . . . . . . 10 688

Shiga Toxin . . . . . . . . . . . . . . . . . . . . . . . 13 793

Sickle Cell . . . . . . . . . . . . . . . . . . . . . . . . .9 739

Skin Scraping. . . . . . . . . . . . . . . . . . . . . 10 609, 639, 641

sO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 721, 723

Sodium . . . . . . . . . . . . . . . . . . . . . . . . 10, 11 612, 616, 617, 618, 619, 700, 717, 718, 721, 722

Sperm analysis (post-vasectomy) . . . . .11 950

SS-A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 757

SS-B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 757

Stool for Fecal Leukocytes. . . . . . . . . . 13 609, 639, 641

Strep Antigen (Group A) . . . . . . . 12, 13 609, 691, 699, 783

Strep Antigen (Group B) . . . . . . . . . . 13 789

Susceptibility, urine . . . . . . . . . . . 12, 13 775, 778, 779, 781, 782, 790

Syphilis Serology (RPR & VDRL) . . . .11 679

T3 (Triiodothryonine) . . . . . . . . . . . . . 10 612, 616, 617, 618, 619

T3 Uptake . . . . . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619, 676

T3, Free . . . . . . . . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619, 676

T4 (Thyroxine) . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619, 676

T4, Free (Free Thyroxine) . . . . . . . . . 10 612, 616, 617, 618, 619, 676

TCO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619, 718, 721, 722, 723

Testosterone, free . . . . . . . . . . . . . . . . . 10 688

Testosterone, total . . . . . . . . . . . . . . . . . 10 686, 688

Theophylline . . . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619

Thyroglobulin . . . . . . . . . . . . . . . . . . . . . .11 708

Thyroid Antibodies . . . . . . . . . . . . . . . . 10 677

Thyroglobulin Antibody (Anti-TG) . . . . . 10 677

Thyroid Stimulating Hormone (TSH) . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619, 676

Thyroid Microsomal Antibody (Anti-TPO) . . . . . . . . . . . . . . . . . . . . . . . . 10 677

TIBC (Total Iron Binding Capacity) . . . 10 612, 616, 617, 618, 619

Tobramycin . . . . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619

Total IgE. . . . . . . . . . . . . . . . . . . . . . . . . .11 671, 674

Total Protein . . . . . . . . . . . . . . . . . . . 10, 11 612, 616, 617, 618, 619, 708, 717, 718

Toxoplasma gondii Antibody . . . . . . . . 12 756

Transferrin. . . . . . . . . . . . . . . . . . . . . . . . 10 686

Trichomonas vaginalis by Affirm® VP . . . . . . . . . . . . . . . . . . . . . . . . 12 771

Tricyclic Antidepressants (urine) . . . . . .11 703, 713

Triglyceride . . . . . . . . . . . . . . . . . 10, 11, 13 600, 612, 616, 617, 618, 619, 717, 718

Troponin I . . . . . . . . . . . . . . . . . . . . . . . . .11 714, 715, 720

Troponin T. . . . . . . . . . . . . . . . . . . . . . 10, 11 701, 720

TSH (Thyroid Stimulating Hormone) . . . . . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619, 676

UIBC . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619

Urea Nitrogen (BUN) . . . . . . . . . . . 10, 11 612, 616, 617, 618, 619, 700, 717, 718, 721, 722

Uric Acid . . . . . . . . . . . . . . . . . . . . . . 10, 11 612, 616, 617, 618, 619, 717, 718

Urine Chemistry . . . . . . . . . . . . . . . . . . . .11 728

Urine Colony Count. . . . . . . . . . . . . 12, 13 661, 784, 785

Urine Dipstick. . . . . . . . . . . . . . . . . . . . . 13 609, 639, 640, 642

Urine Drug Screen. . . . . . . . . . . . . . . . . .11 703, 713

Urine Sediment . . . . . . . . . . . . . . . . . . . 13 609, 639, 641

Vaginal Wet Prep/KOH . . . . . . . . . . . . . 13 609, 639, 641

Valproic Acid . . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619

Vancomycin . . . . . . . . . . . . . . . . . . . . . . 10 612, 616, 617, 618, 619

Vitamin B12 . . . . . . . . . . . . . . . . . . . . . . . 10 686

Vitamin D. . . . . . . . . . . . . . . . . . . . . . . . . 10 685

VLDL . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 717

VRE (Add-on) . . . . . . . . . . . . . . . . . . . . 12 768

VZV (Varicella Zoster Virus) Antibody . . 12 756

WBC (White Blood Cell Count) . . . . .9 606, 610, 611, 613, 614, 745, 746, 747, 752

All CLIA regulated analytes are provided at 5 challenges per event.

Non-regulated analytes are provided at 1-2 challenges per event.

8 2016 Proficiency Testing Program (800) 274-7911

9www.aafp.org/pt

602 Hemoglobin/Hematocrit (waived) . . . (2 specimens) $100

603 Blood Cell IdentificationAvailable when ordered in combination with module 611, 613, 614, 745, 746, 747 or 752 (5 Photographs per event + 1 Educational Photograph) $42

604 Reticulocyte Count . . . . . . . . . . . . . . . . . (1 specimen)Compatible with manual or automated reticulocyte procedures. It is NOT compatible with brilliant cresyl blue staining procedures $216

606 HemoCue WBC . . . . . . . . . . . . . . .(5 specimens) $207

610 Regular Hematology Package. . . . . . . (5 specimens)Blood Cell ID Photographs, Hematocrit, Hemoglobin, Platelet count, RBC, WBC $207

Compatible with all traditional methods including the hemocytometer, microhematocrit, and StatCrit. Does not include a differential

611 QBC Hematology Package . . . . . . . . . (5 specimens)Hematocrit, Hemoglobin, Platelet count, WBC, Automated Diff. (2-part) $261

649 Antibody Detection, Direct (DAT) . . . . (5 specimens) $171

650 Blood Bank. . . . . . . . . . . . . . . . . . . . . . . (5 specimens)Includes ABO Group, Antibody Detection and Identification, Rh Factor (D type), and Compatibility Testing $372

680 Coagulation - Plasma . . . . . . . . . . . . . . (5 specimens) Protime, INR, Activated Partial Thromboplastin Time (APPT), Fibrinogen $$159

For use on all plasma coagulation

730 Sed. Rate . . . . . . . . . . . . . . . . . . . . . . . . . (1 specimen)Compatible with manual or automated Sed Rate procedures $150

736 ABO/Rh Only . . . . . . . . . . . . . . . . .(5 specimens) $270

763 CoaguCheck XS Plus (Waived) . . . . . . (2 specimens)Not compatible with CoaguChek XS $141

764 CoaguCheck XS Plus/XP Pro . . . . . . . (5 specimens)Not compatible with CoaguChek XS $225

739 Sickle Cell Screen. . . . . . . . . . . . . . . . . . (1 specimen)Suitable for all screening methods $156

744 ITC Hemachron CitratedWhole Blood Protime . . . . . . . . . . . . . . . . . . . (5 specimens)For use by labs using the ITC Hemachron instrument with the citrated whole blood methodology $252

748 i-Stat® Protime . . . . . . . . . . . . . . . . . . . . (5 specimens)For use by labs using the i-Stat® or Coagusense instruments $231

621 Platelet Function — Aspirin . . . . . . . . . (2 specimens)Accumetrics VerifyNow $228

622 Platelet Function — P2Y12 . . . . . . . . . . (2 specimens)Accumetrics VerifyNow $228

623 Platelet Function — IIb/IIIa. . . . . . . . . . (2 specimens)Accumetrics VerifyNow $228

Module 613 614 745 746 747 752

PRICE $234 $234 $297 $297 $297 $297

HEMATOLOGY CBC – SELECT MODULE BY INSTRUMENT

Abbott Cell-Dyn 1200, 1400, 1600, 1700, 1800

x

Abbott Cell-Dyn 3000, 3200, 3500/3700, 4000

x

Abbott Emerald x

Abbott Sapphire, Ruby x

Bayer (Siemens) ADVIA 60

x

Beckman-Coulter AcT, AcT Diff2

x

Beckman-Coulter MD8, MD11, MD16

x

Beckman-Coulter S880, T540, T660, T890

x

Beckman-Coulter AcT 5 Dif

x

Beckman-Coulter GEN-S, HmX, LH500, MAXM, MAXM A/L, STKS, LH750, LH780, DXH600

x

CDS Medonic & M series x

Danam/Infolab DC 16, 18, Excell 1800MS, Info I-800

x

Danam/Infolab Excell 22 x

Drew Scientific D3, Evolution

x

Horiba (ABX) Micros/45/60

x

Horiba (ABX) Pentra 60, 60C+, 80, DX 120

x

Mindray 3000/3200 series x

Sysmex CC, E, F, K, NE, R Series, XP-300

x

Sysmex pocH-100i x

Sysmex XE 2100 series, XT 1800i, XT2000i, XS series, SE 5000, XT400i

x

HEMATOLOGY

10 2016 Proficiency Testing Program (800) 274-7911

612 MultiChem 5. . . . . . . . . . . . . . . . . . . . . . (5 specimens) (1-5 Analytes Tested) $243

616 MultiChem 10 . . . . . . . . . . . . . . . . . . . . . (5 specimens) (6-10 Analytes Tested) $270

617 MultiChem 15 . . . . . . . . . . . . . . . . . . . . . (5 specimens) (11-15 Analytes Tested) $297

618 MultiChem 20. . . . . . . . . . . . . . . . . . . . . (5 specimens) (16-20 Analytes Tested) $324

619 MultiChem 21+. . . . . . . . . . . . . . . . . . . . (5 specimens) (21+ Analytes Tested) $381

645 Fetal Membrane Rupture . . . . . . . . . . . (2 specimens) For use with Amnisure ROM only. $285

651 Fructosamine . . . . . . . . . . . . . . . . . . (1 specimen) $144

652 CSF and Body Fluid Analysis. . . . . . . . (3 specimens) Manual cell count, body fluid chemistry, CSF chemistry. $283

915 Body Fluid pH. . . . . . . . . . . . . . . . . . (1 specimen) $204

919 Body Fluid Cell Count. . . . . . . . . . . (1 specimen) $177

662 Neonatal Bilirubin . . . . . . . . . . . . . (5 specimens) $186

663 Neonatal Bilirubin . . . . . . . . . . . . . . . . . (2 specimens) Add-on for any Multi-Chem module $126

664 Whole Blood Glucose . . . . . . . . . . . . . . (2 specimens) For use ONLY with hand-held whole blood glucose monitors. Specimens are not compatible with the HemoCue glucose instruments (see Module #608) $129

666 Glycohemoglobin, Affinion – WAIVED (1 specimen) $183

667 PSA - Add On . . . . . . . . . . . . . . . . . . . . . . . (1 specimen) Must be added to chemistry modules 612-619. $35

669 Whole Blood Glucose . . . . . . . . . . . . . . (5 specimens) For use ONLY with hand-held whole blood glucose monitors. Specimens are not compatible with the HemoCue glucose instruments (see Module #608) $246

672 Glycohemoglobin . . . . . . . . . . . . . . . . . . (1 specimen) (GHB / Hemoglobin A1C) $183

676 Endocrinology . . . . . . . . . . . . . . . . . . . . (5 specimens) T3, Free T3, T3 Uptake, T4 (Thyroxine), Free T4, TSH, hCG, Cortisol $195

677 Thyroid Antibodies . . . . . . . . . . . . . . . . (2 specimens) Thyroglobulin antibody (Anti-TG), Thyroid Microsomal antibody (Anti-TPO) $276

686 Special Chemistry . . . . . . . . . . . . . . . . . . (1 specimen) CEA, DHEA Sulfate, Estradiol, Estriol, Ferritin. Folate. FSH, Homocysteine, LH, PAP, Prealbumin, Progesterone, Prolactin, PSA, Testosterone, Transferrin, Vitamin B12 $222

685 Special Chemistry II . . . . . . . . . . . . . . . (2 specimens) Lyophilized including C-peptide, Insulin, PTH, Vitamin D $153

687 Ammonia. . . . . . . . . . . . . . . . . . . . . (2 specimens) $168

688 SHBG and Testosterone. . . . . . . . . . . . (2 specimens) Sex Hormone Binding Globulin (SHBG), free testosterone, total testosterone $396

700 i-STAT® Chemistry . . . . . . . . . . . . . . . . (5 specimens) For G, Crea, E3+, EC4+, CHEM 8+, and 6+ Cartridges $261

721 i-STAT®Chemistry/Blood Gas Combo (5 specimens) Plus EG6+, EG7+, CG8+, EC8+ Cartridges $270

722 i-STAT® Chemistry – WAIVED . . . . . . . . (1 specimen) For CHEM8+, 6+, EC4+, E3+, G, Crea $174

723 i-STAT® Blood Gases . . . . . . . . . . . . . . (5 specimens) For G3+, CG4+ Cartridges $234

701 Troponin T . . . . . . . . . . . . . . . . . . . . . . . . (1 specimen) for Roche Cardiac T Rapid Test and Roche Trop T Sensative Assay only $213

702 Blood Gases. . . . . . . . . . . . . . . . . . . . . . (5 specimens) pH, pCO2, pO2, and ionized Calcium These specimens are compatible with all other blood gas analyzers, except iStat (see Module 723) $384

AcetominophenAFPAlbuminAlkaline PhosphataseALT/SGPTAmikacinAmylaseAST/SGOTBilirubin, ConjugatedBilirubin, UnconjugatedCalciumCarbamazepineChlorideCholesterolCKCO2

CortisolCreatinineDirect BilirubinDigoxin

EthosuximideGentamicinGGTGlucosehCG (Quant.)HDL CholesterolIronLactic AcidLDLLDHLipaseLithiumMagnesiumN-acetyl Procainamide

(NAPA)OsmolalityPhenobarbitalPhenylalaninePhenytoinPhosphorousPotassiumPrimidone

ProcainamideQuinidineSalicylateSodiumT3T3, FreeT3 UptakeT4 (Thyroxine)T4, FreeTSHTheophyllineTIBCTobramycinTotal BilirubinTotal ProteinTriglycerideUIBCUrea Nitrogen (BUN)Uric AcidValproic AcidVancomycin

MultiChem Package AnalytesAll MultiChem modules include 5 specimens per shipment. Order packages 612, 616, 617, 618, or 619 according to the number of chemistry analytes tested in your lab.

The chemistry analytes included in these packages are:

CHEMISTRY

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703 Urine Drug Screen (10 ml) . . . . . . . . . . (2 specimens) Acetaminophen, Amphetamines, Barbiturates, Benzodiazepines, Buprenorphine, Cannabinoids (THC), Cocaine Metabolites, Cotinine, EDDP, Ethanol, LSD, MDMA (Ecstasy), Methamphetamine, Methadone, Methaqualone, Opiates, Oxycodone, PCP, Propoxyphene, Tricyclic Anti-depressants, 6-monoacetylmorphine, pH, Specific gravity $222

713 Urine Drug Screen (50 ml). . . . . .(2 specimens) $285

705 Urine Microalbumin & Creatinine . . . . . (1 specimen) Microalbumin and Creatinine – quantitative and semi-quantitative determinations $141

708 Tumor Markers. . . . . . . . . . . . . . . . . . . . (5 specimens) AFP, CA 15-3, CA 125, CA-19-9, PSA (Free), PSA (Total), CA-27/29, CEA, Thyroglobulin, Total protein, -2 Microglobulin $396

709 Blood Lead . . . . . . . . . . . . . . . . . . . . . . . (5 specimens) Whole blood lead determination $462

716 Blood Lead (Waived) . . . . . . . . . . . . . . . (1 specimen) Whole blood lead determination – Waived methods $198

711 BNP . . . . . . . . . . . . . . . . . . . . . . . . . . (1 specimen) $246

740 D-Dimer (Qualitative and Quantitative) (1 specimen) $144

712 Apolipoproteins and Lp(a) . . . . . . . . . . (2 specimens) Apolipoprotein A1, B, C, E and Lp(a) $147

714 Complete Cardiac Markers . . . . . . . . . (5 specimens) CK, CKMB, Myoglobin, Troponin I, Troponin T, BNP, NT proBNP, D-Dimer $243

For use by labs using the Biosite Triage system and other quantitative methods

715 Basic Cardiac Markers . . . . . . . . . . . . . (5 specimens) CKMB, Myoglobin, Troponin I $207

For use by labs using the Biosite Triage system and other quantitative methods

720 Cardiac Markers I . . . . . . . . . . . . . . . . . (2 specimens) Myoglobin, Troponin I, Troponin T, BNP, NT proBNP, D-Dimer $180

717 Abaxis Piccolo® (Waived) . . . . . . . . . . . (1 specimen) For the Abaxis Piccolo® reagent discs – Comprehensive Metabolic Panel, Basic Metabolic, Electrolytes, Kidney Check, Lipid, Lipid Panel Plus, General Chemistry 13, Liver Panel Plus, General Chemistry 6, Metlyte 8, and Renal Panel $183

718 Abaxis Piccolo® (Non-Waived) . . . . . . (5 specimens) For the Abaxis Piccolo® reagent discs – Basic Metabolic Plus, Hepatic Panel, Biochemistry Plus, and Metlyte Plus CRP $261

719 Quantitative hCG (Serum) . . . . . . (5 specimens) $135

724 Urine hCG (nonwaived) . . . . . . . . (5 specimens) $144

726 NTproBNP. . . . . . . . . . . . . . . . . . . . . (1 specimen) $252

727 Blood Alcohol/Acetone . . . . . . . .(5 specimens) $287

728 Urine Chemistry. . . . . . . . . . . . . . . . . . . (2 specimens) Amylase, Calcium, Chloride, Cortisol, Creatinine, Glucose, Magnesium, Phosphorus, Potassium, Sodium, Total Protein, Urea Nitrogen, Uric Acid $264

950 Post Vasectomy Sperm Analysis. . . . . (2 specimens) Presence/absence of sperm $246

IMMUNOLOGY/VIROLOGY643 ANA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (5 specimens)Antinuclear Antibody (latex methods, qualitative and quantitative) $150

644 H. pylori . . . . . . . . . . . . . . . . . . . . . . . . . . (1 specimen)H. pylori Antibody Detection $135

653 Rheumatoid Factor . . . . . . . . . . . . (5 specimens) $144

654 Lyme Serology . . . . . . . . . . . . . . . . (1 specimen) $204

655 Immunoproteins . . . . . . . . . . . . . . (5 specimens) $198 IgA, IgG, IgM, C3, C4, Alpha-1 Antitrypsin

671 Total IgE . . . . . . . . . . . . . . . . . . . . . (5 specimens) $129

673 Rubella (Qualitative & Quantitative) . . (5 specimens) Rubella Antibody Detection $144

674 Diagnostic Allergy . . . . . . . . . . . . . . . (5 specimens) Allergen Specific IgE, Total IgE (quantitative and/or semi-quantitative) $306

765 Allergen Testing. . . . . . . . . . . . . . . . . . . . (1 specimen) Allergen Specific Testing $135

675 Infectious Mononucleosis . . . . . . . . . (5 specimens) IgM or IgG $144

678 Serum hCG . . . . . . . . . . . . . . . . . . . . . . (5 specimens) Qualitative serum pregnancy test $144

679 Syphilis Serology . . . . . . . . . . . . . . . . . (5 specimens) RPR, VDRL (qualitative and quantitative) $162

683 ASO / CRP . . . . . . . . . . . . . . . . . . . . . . . (6 specimens) Includes 5 specimens for ASO testing and 1 specimen for CRP testing $195

684 CRP (Qualitative & Quantitative) . . . . . (2 specimens) $135

750 Viral Markers . . . . . . . . . . . . . . . . . . . . . (5 specimens) HBsAg, HBeAg, Anti-HBc, Anti-HBs, Anti-HCV, Anti-HIV, Anti-HAV, HCV $399

751 Infectious Mononucleosis / EBV. . . . . (5 specimens) Epstein - Barr Nuclear Antigen $189

Note: This material is compatible with the Meridian Monolert test kit and any other mono kit that detects EBV only

753 Infectious Mononucleosis . . . . . . . . . . . (1 specimen) Waived methods only. $75

754 Infectious Mono / RF Combo Pkg. . . (5 specimens) For Mono testing, 5 specimens for Rheumatoid Factor testing $228

755 HIV Antigen. . . . . . . . . . . . . . . . . . . . (1 specimen) $351

12 2016 Proficiency Testing Program (800) 274-7911

756 Viral Antibodies . . . . . . . . . . . . . . . . (1 specimen) $180 CMV, EBV, HSV, Rubella Virus, Rubeola Virus, Toxoplasma gondii, VZV, Paramyxovirus IgG & IgM

757 Special Immunology . . . . . . . . . . . . . . . (5 specimens)

ANA, Anti-RNP, Anti-SM, Anti-DNA, SS-A, SS-B $141

758 Mycoplasma Antibody . . . . . . . . . . . . . . (1 specimen) Suitable for all methods. $165

759 Complete Immunology . . . . . . . . . . . . (5 specimens) Infectious Mono, RF, ASO, Rubella, Serum pregnancy $405

760 ANA (ELISA) . . . . . . . . . . . . . . . . . (5 specimens) $147

761 High Sensitivity CRP . . . . . . . . . . . . . . . . (1 specimen) Suitable for all methods $141

762 HIV Antibody (Waived) . . . . . . . . . . . . . . (1 specimen) Waived methods only $153

766 HIV Antibody. . . . . . . . . . . . . . . . . .(5 specimens) $348

767 Hepatitis Markers . . . . . . . . . . . . . . . . (5 specimens) HBsAg, HBeAg, Anti-HBs, Anti HCV, Anti-HBc, Anti-HAV, HCV $387

932 Hepatitis C Antibody (Waived) . . .(2 specimens) $249

931 Anti-CCP . . . . . . . . . . . . . . . . . . . . . . . . . (2 specimens) Qualitative/quantitative $297

MICROBIOLOGY Module InformationThe specialty of Microbiology has unique CLIA PT performance requirements specified in their regulations:

Five challenges three times per year must be performed. These challenges can be all one type of testing or a combination of several types of testing. Bacterial cultures and antigen detection methods are both classified as testing procedures in bacteriology and can each be counted together toward these challenge requirements. Viral antigen detection should be considered separately at five challenges three times per year. AAFP-PT has constructed several modules designed to provide your laboratory with the number of challenges required by CLIA at the lowest cost.

Antigen Detection PackagesWhen selecting your test packages, please remember that CLIA regulations require five challenges of both bacterial and viral specimens three times per year. If you do viral antigen detection methods, refer to module #770, Viral Antigen Detection.

Culture PackagesThese packages are designed for laboratories performing cultures (and susceptibilities if applicable) from one or more sources. You should select the package that covers all or most of the sources tested in your lab.

661 Urine Colony Count. . . . . . . . . . . . . . . . . (1 specimen)Urine Colony Counts are not regulated by CLIANote: If your laboratory performs presumptive IDs, refer to modules 784 and 785. $171

668 Gram Stain (Glass Slides) . . . . . . (5 specimens) $144

691 Group A Strep (5 Specimens) . . . . . . . (5 specimens)Antigen Detection for Group A Strep (swabs)/CLIA regulated $174

665 Group A Strep . . . . . . . . . . . . . . . (2 specimens) $90

699 Group A Strep (1 Specimen) . . . . . . . . . (1 specimen)For waived methods only $84 Note: This package is designed for laboratories using kits that have been classified as waived according to CLIA ‘88 regulations.

768 MRSA/VRE (Add-on) . . . . . . . . . . . . . . (2 specimens)For culture or PCA methods — must be ordered with another culture module $198

769 Campylobacter Antigen . . . . . . . . (2 specimens) $108

770 Viral Antigen Detection Package . . . . (5 specimens)Influenza A, Influenza B, RSV $291

792 Viral Antigen Detection (Waived) . . . . (2 specimens)Influenza A, Influenza B, RSV-waived methods $132 Note: Ships A & C events only

797 Viral Antigen Detection II . . . . . . . . . . . (5 specimens)Influenza A, Influenza B, Rotavirus, RSV, Adenovirus $291

798 Viral Antigen Detection (ROT) . . . . . . . (5 specimens)Influenza A, Influenza B, Rotavirus, RSV $291

771 Affirm VP Package. . . . . . . . . . . . . . . . . (5 specimens)DNA Probe testing for Candida sp., Gardnerella vaginalis, Trichomonas vaginalis $351

772 Dermatophyte Culture/Screen . . . . . (5 specimens)Designed for all dermatophyte culture techniques including DTM methods. Qualitative results (present/not present) are non-regulated; identification is regulated $231

773 Candida Detection Package . . . . . . . . (5 specimens)For culture and antigen detection of all Candida species $279

774 GenProbe GC/Chlamydia . . . . . . . . . . (5 specimens)DNA Probe testing compatible with the GenProbe system and all other DNA Probe Techniques $354

775 Urine Culture . . . . . . . . . . . . . . . . . . . . . (5 specimens)For labs performing only urine cultures with ID and/or susceptibility testing. Not acceptable for labs reporting only colony counts $255

776 Throat Culture . . . . . . . . . . . . . . . . . . . . (5 specimens)For labs performing only throat cultures $255

777 Genital Culture . . . . . . . . . . . . . . . . . . . (5 specimens)For labs performing only genital cultures $255

796 Genital Culture – Add-on . . . . . . . . . . (2 specimens)Must be ordered in combination with another culture module $108

778 Urine & Throat Culture . . . . . . . . . . . . . (5 specimens)For labs performing urine and throat cultures only $255

779 Urine & GC Culture . . . . . . . . . . . . . . . . (5 specimens)For labs performing urine and genital cultures only $255

780 Throat & GC Culture . . . . . . . . . . . . . . . (5 specimens)For labs performing throat and genital cultures only $255

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781 Urine, Throat, & GC Culture . . . . . . . . . (5 specimens)For labs performing urine, throat and genital cultures $255

782 Complete Bacteriology. . . . . . . . . . . . . (7 specimens)For labs performing cultures on all/or most body sites. Sources covered throughout the year include urine, thro55at, genital, blood, CSF, ear, eye, skin, sputum, stool, and wound $273

783 Group A Strep – Add On (2) . . . . . . . . (2 specimens)This package must be added on to the culture modules 775-782 $36

784 Presumptive ID/Colony Count - Urine . . . . . . . . . . . . . . . . . . . . . . . . . . (5 specimens)Suitable for paddle and tube cultures/CLIA regulated $273

785 Presumptive ID/Colony Count – Urine/Strep Combo. . . . . . . . . . . . . . . . . . . . . (5 specimens)

Suitable for paddle and tube culture colony counts with presumptive ID’s and non-waived strep antigen testing/CLIA regulated $273

786 Parasitology . . . . . . . . . . . . . . . . . . . . . . (5 specimens)Specimens include fecal suspension examination, PVA slides and/or blood smears $270

787 Giardia Antigen Detection . . . . . . . (1 specimen) $123

971 Giardia/Cryptosporidum Antigen Detection . . . . . . . . . . . . . . . . . . . . . . . . .(5 specimens) $252

972 Giardia/Cryptosporidium Antigen Detection . . . . . . . . . . . . . . . . . . . . . . . . . (2 specimens) $147

788 Acid Fast Smear. . . . . . . . . . . . . . . (5 specimens) $168

789 Bacterial Antigen Detection . . . . . . . (5 specimens)Includes Chlamydia, Group B Strep and C. difficile GDH Antigen and C. difficile Toxin A/B $285

790 Urine Susceptibility Add-On . . . . . . . . . (1 specimen)This package may be added onto Modules 661, 784 and 785. Susceptibility testing is regulated under CLIA. $27

793 Shiga Toxin 1 & 2 . . . . . . . . . . . . . . (1 specimen) $189

794 GC + Chlamydia Antigen Detection 5 . . . (5 samples) $309

795 GC + Chlamydia Antigen Detection 2 Add-on . . . . . . . . . . . . . . . . . . . . (2 specimens)This package must be added on to the culture modules 775-782 $108

WAIVED/PPM AND URINALYSIS MODULES600 Cholestech LDX/CardioCheck Package . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (1 specimen)ALT, AST, Cholesterol, Glucose, HDL Cholesterol, Triglyceride Cholestech LDX & CardioCheck instruments only $153

602 Hematocrit (spun) . . . . . . . . . . . . . (2 specimens) $100

608 HemoCue Glucose / Hemoglobin . . . . (1 specimen)HemoCue Glucose, HemoCue Hemoglobin, HemoCue instruments only $129

609 Waived/PPM Module Includes: Urinalysis components, Clinical Microscopy, Urine hCG, Whole Blood Glucose (Hand-Held methods only — NOT HemoCue), Hemoglobin (including HemoCue), Hematocrit (spun or StatCrit), Fecal Occult Blood, Group A Strep Antigen (waived method), Infectious Mono. (waived method) $297

638 Urine Sediment Microscopy $42

639 Complete Urinalysis PackageUrinalysis components + Urine hCG + Clinical Microscopy $126

640 Urinalysis . . . . . . . . . . . . . . . . . . . . . . . . . (1 specimen) Urinalysis components include: Bilirubin, Blood/HgB, Glucose, Leukocyte Esterase, Nitrite pH, Protein, Specific Gravity, Urobilinogen, Microalbumin (qualitative) $81

637 KOH (glass slides) . . . . . . . . . . . . . . . . (2 specimens)Hair, skin, nails, not suitable for vaginal wet preps $168

641 Clinical MicroscopyEach shipment will include 6 photographs representing a selection from the following sources: Urine Sediment, Vaginal Wet Prep, KOH - Skin Scraping, Stool for Pinworms/Leukocytes, Nasal Smears, Fern Testing $150

642 Urinalysis/ hCG . . . . . . . . . . . . . . . . . . . . (1 specimen)Urinalysis components, Urine hCG $84

647 Urinalysis/hCG/Fecal Occult Blood $99

666 Glycohemoglobin, Affinion – WAIVED. . . (1 specimen) $180

791 Fecal Occult Blood Add-on . . . . . . . . . . (1 specimen)Must be ordered in conjunction with Module, 639, 640, 641 or 642 $30

763 CoaguChek XS Plus (Waived) . . . . . . . (2 specimens)Not compatible with the CoaguChek XS $138

716 Blood Lead (Waived). . . . . . . . . . . . . . . . (1 specimen)Whole blood lead determination — Waived methods $177

717 Abaxis Piccolo® (Waived) . . . . . . . . . . . . (1 specimen)For the Abaxis Piccolo® reagent discs – Lipid, Lipid Panel Plus, Liver Panel Plus and General Chemistry 6, General Chemistry 13, Kidney Check, Electrolytes, Basic Metabolic Panel, Comprehensive Metabolic Panel, Metlyte 8, Renal Panel $180

722 i-STAT® Chemistry (Waived) . . . . . . . . . . . (1 specimen)For CHEM8+, 6+, EC4+, E3+, G, and Creat Cartridges $171

753 Infectious Mononucleosis . . . . . . . . . . . (1 specimen)Waived methods only $75

699 Group A Strep . . . . . . . . . . . . . . . . . . . . . (1 specimen)(1 specimen — for waived methods only) $84

792 Viral Antigen Detection (Waived) . . . . (2 specimens)Influenza A. Influenza B, RSV-waived methods $132 (Ships A & C events only)

Please examine your kit upon receipt. If you have incomplete or damaged PT material, please contact AAFP-PT.

Although every effort is made to assure that your kit arrives cool, please refrigerate the specimens overnight before testing.

Every effort is made to accommodate replacement requests depending on the availability of testing material at that time.

If you have questions concerning your PT materials, please call the American Academy of Family Physicians at (800) 274-7911.

SHIPMENT SCHEDULE

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MAYKit 2016 - A• March 7 — Kit Shipment• If kit not received by

March 11, please call• March 23 — Last day for

replacements • March 30 — Results

submission deadline • April 29 — Evaluations available

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Kit 2016 - B• June 6 — Kit Shipment• If kit not received by

June 10, please call• June 22 — Last day for

replacements • June 29 — Results

submission deadline • July 29 — Evaluations available

Kit 2016 - C• October 3 — Kit Shipment• If kit not received by

October 7, please call• October 19 — Last day for

replacements • October 26 — Results

submission deadline • November 25 — Evaluations

available

The right choice for proficiency testing.

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