HUSM/LCD/QP-22
MEDICAL LABORATORIES
HOSPITAL UNIVERSITI SAINS
MALAYSIA
REVIEW OF CONTRACTS
Prepared by: Assoc. Prof. Dr Rosline Hassan
Approved by: Dr Zaidun Kamari
Effective
date: 01.11.2009
MEDICAL LABORATORIES HOSPITAL UNIVERSITI SAINS MALAYSIA
Page 1 of 8
Version 1
REVIEW OF CONTRACTS
HUSM/LCD/QP-22
Title: TABLE OF CONTENT
Amendment 1
PAGE TABLE OF CONTENT
1 Table of content
2 Record of Amendment
3 Record of Review
4 Objective , Scope References, Definition & Abbreviation
5 Responsibility
6 Procedure
7 Records
8 Flow Chart
Appendices
Appendix 1 : Agreement document
Appendix 2 : Registration form for laboratory services
Appendix 3 : Checklist
Appendix 4a : Carta Aliran Makmal (diuruskan oleh USAINS tech services) Appendix 4b : Carta Bayaran Perkhidmatan USAINS
Appendix 5 : Borang ujian Makmal (Unit Kewangan) Appendix 6 : Borang tuntutan melalui USAINS
Prepared by
Approved by
Assoc. Prof. Dr Rosline Hassan
Dr Zaidun Kamari
Effective Date 01.11.2009
MEDICAL LABORATORIES HOSPITAL UNIVERSITI SAINS MALAYSIA
Page 2 of 8
Version 1
REVIEW OF CONTRACTS
HUSM/LCD/QP-22
Title: RECORD OF AMENDMENT
Amendment 3
RECORD OF AMENDMENT
VERSION
NO.
VERSION
DATE
DESCRIPTION OF AMENDMENT SIGNATURE OF APPROVAL
1 1.11.2009 Changes of version MS ISO 15189:2004
to new version MS ISO 15189:2007
1 1.11.2009 Transforming version 1 MS ISO
15189:2007 into electronic document web
address:
http://www.quality.kck.usm.my/HUSM/MS
ISO 15189:2007
1 1.11.2009
(Effective
date
29/04/2010)
Ammendment 1:
Page 5 of 7, 7.5 Change to:
Dispatch results to:
i. doctor who request the test or/and
ii. laboratory physician
1 1.11.2009
(Effective
date
29/04/2010)
Ammendment 2:
Appendix 3: New form
VERSION
NO.
AMENDMENT
DATE
DESCRIPTION OF AMENDMENT SIGNATURE OF APPROVAL
1 1.08.2010 Document was reviewed on the 14.7.2010
Amendment 3: pg 2 of 8
Version Date was replaced by Date of
Amendment. Added record of review.
Amendment 4: pg 3 of 8
Revised thoroughly at page 5 and add i.
appendix 4a: Carta alir makmal (diuruskan oleh Usains). ii. Appendix 4b : Carta alir cara bayaran perkhidmatan Usains.
Prepared by
Approved by
Assoc. Prof. Dr Rosline Hassan
Dr Zaidun Kamari
Effective Date 01.11.2009
MEDICAL LABORATORIES HOSPITAL UNIVERSITI SAINS MALAYSIA
Page 3 of 8
Version 1
REVIEW OF CONTRACTS
HUSM/LCD/QP-22
Title: RECORD OF REVIEW
Amendment 3,4
DATE OF REVIEW NAME OF REVIEWER APPROVED BY
14 Jul 2010
Dr. Rapiaah Mustaffa
Pn. Norizah Tumin
Prepared by
Approved by
Assoc. Prof. Dr Rosline Hassan
Dr Zaidun Kamari
Effective Date 01.11.2009
MEDICAL LABORATORIES HOSPITAL UNIVERSITI SAINS MALAYSIA
Page 4 of 8
REVIEW OF CONTRACTS
HUSM/LCD/QP-22
Title: OBJECTIVE, SCOPE,
REFERENCES, DEFINITION AND
ABBREVIATION
Version 1
1. OBJECTIVE
To describe the procedures for review contracts to customer requiring medical laboratory
services.
2. SCOPE
This procedure is to be applied to all customers requiring medical laboratory services from
Medical Laboratories in Hospital Universiti Sains Malaysia.
3. REFERENCES
3.1 Laboratory Quality Manual: HUSM/LCD/QM
3.2 MS ISO 15189 Standards
4. DEFINITION
Routine test : Series of tests that are done during office hours and do not require
appointment
Special Test : Series of tests that are done in batches and do/do not require
appointment
STAT Test : Series of tests that are done during or after office hours and do not
require appointment but results are needed urgently
External Customer :Customers who are medical officer, clinicians working in other health
care institutions, health insurance companies, pharmaceutical
companies requesting for medical laboratory services
Internal Customer :Customers working in HUSM who are medical officer and/or clinicians,
requesting for medical laboratory services
Batches : Test run in group within the specific time
5. ABBREVIATION
LD : Laboratory Director
TM : Technical Manager
SO : Scientific Officer
QM : Quality Manager
MLT : Medical Laboratory Technologist
Prepared by
Approved by
Assoc. Prof. Dr Rosline Hassan
Dr Zaidun Kamari
Effective Date 01.11.2009
MEDICAL LABORATORIES HOSPITAL UNIVERSITI SAINS MALAYSIA
Page 5 of 8
REVIEW OF CONTRACTS
HUSM/LCD/QP-22
Title: RESPONSIBILITY
Version 1
6. RESPONSIBILITY
6.1 Laboratory Director
- Responsible for the contract made between customers and laboratory services
6.2 Quality Manager
- Responsible in the implementation of the contract procedure
6.3 Scientific Officer / Technical manager
- Responsible in the maintenance of laboratory procedures in accordance to Quality
Management system
Prepared by
Approved by
Assoc. Prof. Dr Rosline Hassan
Dr Zaidun Kamari
Issued Date
Effective Date
01.11.2009
MEDICAL LABORATORIES HOSPITAL UNIVERSITI SAINS MALAYSIA
Page 6 of 8
REVIEW OF CONTRACTS
HUSM/LCD/QP-22
Title: PROCEDURE
Version 1
7. PROCEDURE
No Activity Responsibility
7.1
7.2
7.3
7.4
7.5
7.6
Identify the customers
7.1.1 Customer requesting for laboratory test will be
identified either as internal or external customer
7.1.2 For both customers, the tests and related information
are made available by medical laboratories.
Prepare contract details
7.2.1 For internal customers
The arrangement may be in the form of memorandum, manual,
circular, letter, minutes of meeting
7.2.2 For external customers
a) Prepare contract documents consisting :
i. List of tests offered and/or cost for each test (note : cost
of test may differ depends on customers either private or
MOH)
ii. Agreement document (Appendix 1)
iii. Registration form for laboratory services (Appendix 2)
b)Send contract review to customer
c)The customer is expected to fill in the documents and send
them back to the respective laboratory
Upon receipt of contract documents from customer proceed
with the approval from lab director
7.3.1 Based on checklist (Appendix 3) send to customer
a) letter of approval with acknowledgement in case of any
deviation in the contract
b) Documents related to the test requested
Proceed to tests as requested
Despatch results accordingly
Acknowledge Unit Kewangan HUSM if customer from
Ministry of Health or USAINS if customers are from private
hospital/clinic
7.6.1 Follow the flowchart as in Appendix : 4a and 4b
7.6.2 Send the borang ujian makmal to Unit Kewangan
(Appendix 5 : Husm/Kew/BUM/06) or USAINS Holding BHD
(Appendix 6) if application is from private hospital
LD
LD/QM
QM/TM
LD
TM/SO/MLT
TM/SO/MLT
TM/SO/MLT
Prepared by
Approved by
Assoc. Prof. Dr Rosline Hassan
Dr Zaidun Kamari
Effective Date 01.11.2009
MEDICAL LABORATORIES HOSPITAL UNIVERSITI SAINS MALAYSIA
Page 7 of 8
REVIEW OF CONTRACTS
HUSM/LCD/QP-22
Title: RECORD
Version 1
8. RECORD
Prepared by
Approved by
Assoc. Prof. Dr Rosline Hassan
Dr Zaidun Kamari
Effective Date 01.11.2009
No.
Record
Retention of Records
1.
Records of contract documents
At least 5 years
2.
Records of contract amendment
At least 5 years
Proceed to tests
MEDICAL LABORATORIES HOSPITAL UNIVERSITI SAINS MALAYSIA
Page 8 of 8
REVIEW OF CONTRACTS
HUSM/LCD/QP-22
Title: FLOWCHART
Version 1
9. FLOWCHART
Prepared by
Approved by
Assoc. Prof. Dr Rosline Hassan
Dr Zaidun Kamari
Effective Date 01.11.2009
Prepare contract details
Agreement between
client and respective
Medical Laboratory
Yes
No
Reject with
explanation
Despatch results to customer
Identify the customer
Acknowledge to
Unit Kewangan HUSM
Appendix 1
AGREEMENT DOCUMENT Ref No:
BETWEEN _________________ LABORATORY SERVICE HOSPITAL USM AND MINISTRY OF HEALTH OR
PRIVATE HOSPITAL DATE :______________________________
Description of Customer
1. Name of Hospital: _____________________________________________________
2. Licence No. : _____________________________________________________
3. Address : _____________________________________________________
4. Office Phone No.: _____________________________________________________
5. Fax No. : _____________________________________________________
6. Name of Customer : ______________________________________________________
Designation : ______________________________________________________ NRIC No. : ________________________________ H/P No. : ________________________________ Signature : ________________________________
7. Name of Lab Director:
NRIC No. : _________________________
Tel. No (O) : _________________________ H/Phone No. : __________
Signature : _________________________
8. Name of Hospital Director : ______________________ Signature : _______________________
HOSPITAL UNIVERSITI SAINS MALAYSIA 16150 KUBANG KERIAN, KELANTAN
Tel: 09-7673000 (General Line) Fax: 09-7648277
HOSPITAL UNIVERSITI SAINS MALAYSIA 16150 KUBANG KERIAN, KELANTAN
Tel: 09-7673000 (General Line) Fax: 09-7648277
REGISTRATION FORM FOR LABORATORY SERVICE Ref No: Hospital: _____________________________ Tel: ________________ Fax: ______________
Address : ___________________________________________________________________________ ____________________________________________________________________________ Name of Medical Laboratory, HUSM: _______________________Date : _____________________ Type of Test Requested :
1. 2.
3. 4.
5. 6.
7. 8.
9. 10.
Choice of payment ( please underline) : Subsidized from Own Hospital / Individual payment ( FOR MINISTRY OF HEALTH HOSPITAL ONLY)
Name of customer :__________________________
Designation :___________________________
Signature :___________________________
Laboratory results despatch to:
Name:___________________________
Department/Unit:___________________
Address:
______________________________
For Lab Used Only Request : Approved Reject : (Reason) ______________________
Approval Number : __________________________________
Name Lab Director : ___________________________________
Date : __________________________________
Appendix 2
Appendix 3
CHECK LIST FOR REVIEW OF CONTRACT
Name of Medical Laboratory
.
Requesting officer:
Date of request: Institution:
Please tick (√) at relevant section:
Verbal:
Type of tests requested :
Written:
STEPS AFFECTED
DETAILS
A) Pre analytical
1 Type of sample
Blood/ Bone marrow
Serum/plasma
DNA/RNA
2 Transportation
3 Receiving sample
B) Analytical
1 Test method
C) Post analytical
1 Turn around time
2 Costing
D) Quality assurance program
Other documentations relevant to
review of contract if any eg : flowchart
Approved by Lab Director :
Appendix 4a
CARTA ALIRAN MAKMAL (DIURUSKAN OLEH USAINS TECH SERVICES SDN. BHD.)
Organisasi/Hospital/Individu
Pendaftaran di Kaunter Klinik Usains - Perlu dicop oleh staf Usains untuk
pengesahan
Borang Lengkap
Individu membuat bayaran terus - Bayar secara Tunai/Cek - Resit dikeluarkan oleh
Usains
SAMPEL dihantar ke makmal berkenaan
Keputusan dari makmal
Makmal perlu mengisi borang BPM Usains
Keputusan hantar ke klinik Usains
POS keputusan kepada pihak berkenaan dan disertakan
bil/inbois
AMBIL KEPUTUSAN SENDIRI di Klinik Usains bayaran terus
secara Tunai/Cek atau bil/inbois
Borang yang tidak lengkap
TAMAT
Appendix 4b
CARTA BAYARAN PERKHIDMATAN USAINS
Organisasi / Hospital / Individu
Terima keputusan dari makmal berkenaan
beserta inbois dari Usains
Buat bayaran kepada
‘USAINS TECH SERVICES SDN BHD’
Cara bayaran : Tunai/Bank in/Cek
Alamat Pos : Usains Tech Services Sdn. Bhd.
Kampus Kesihatan
Universiti Sains Malaysia
16150 Kubang Kerian Kelantan
Account No. : CIMB Bank 0305-0011151-05-2
Pengesahan bayaran oleh pihak Usains
Pihak Usains akan mengeluarkan resit rasmi dan
akan dipos atau difax kepada pihak berkenaan
TAMAT
Sekiranya pembayaran secara
Bank in, EFT atau IBG, sila
hantar pos/fax butiran yang
berkenaan
Tel : 09 – 767 3801 / 6958
Fax : 09 – 765 1724
Tindakan susulan:
Penyata Akaun,
Panggilan Telefon
Tindakan Undang-
Undang
Tidak membuat
pembayaran
UNIT KEWANGAN
HOSPITAL UNIVERSITI SAINS MALAYSIA
16150 KUBANG KERIAN, KELANTAN
BORANG UJIAN MAKMAL
RUJUKAN DARIPADA / KEPADA : _______________________________________________
NAMA PESAKIT : WAD/UNIT :
NO. R/N : MAKMAL RUJUKAN :
I/C : TARIKH :
* Sila tandakan ( √ ) di mana kotak yang berkaitan.
DARIPADA PIHAK LUAR KE HOSPITAL USM
DARIPADA HOSPITAL USM KE PIHAK LUAR
Tujuan:
Sebab-sebab perlu dihantar keluar :
Jenis-jenis Ujian :
Anggaran setiap sampel :
Tandatangan Pemohon : (Ketua Unit/Jabatan/Penyelaras)
Kelulusan Pengarah :
Tandatangan :
Tarikh :
Tujuan:
Sebab-sebab perlu dihantar keluar :
Jenis-jenis Ujian :
Anggaran setiap sampel :
Tandatangan Pemohon :
(Ketua Unit/Jabatan/Penyelaras)
Kelulusan Pengarah :
Tandatangan :
Tarikh :
* Setiap borang yang telah lengkap diisi berserta lain-lain dokumen berkaitan hendaklah dihantar ke Kaunter Taksiran dan
Hasil, HUSM untuk tindakan selanjutnya.
* Sila guna lampiran sekiranya ruangan tidak mencukupi.
Appendix 5:
Husm/Kew/BUM/06
Appendix 6
Borang Tuntutan melalui USAINS
Makmal Perubatan :
Bulan :
Tarikh Nama
Pesakit
No
Pendaftaran
Pesakit
Wad/Klinik Jenis
Ujian
Kos
pakai
habis
Kos
sumber
manusia
Jumlah
Kos (RM)
Nama Pegawai :
Tandatangan :