Transcription of Urine Dipstick Visual Quality Control Log (Outpatient ...
1 Title (with LTR): Urine Dipstick Visual Quality Control Log Outpatient sites (LTR5271)Revised: 2/19/2013 11:16:10 AM1 Urine Dipstick Visual Quality Control Log (Outpatient sites) using Siemens Multistix 8 SG Urinalysis StripsMultistix Strip Lot # _____ Expiration: _____ Site/Location: _____Sentry Urine Dipstick ControlNORMAL Control Lot # Exp _____Sentry Urine Dipstick ControlABNORMAL Control Lot # Exp _____ Posted Range:Date testedGlucoseKetoneSpecific GravityB l o o dp HProteinNitriteLeukocytesGlucoseKetoneSp ecific GravityBloodp HProteinNitriteLeukocytesCorrective ActionOperatorIf one or more of the tests listed exceed the posted range, repeat the test. If the repeat test result also exceeds the range, refer to the troubleshooting table on this page and enter the Corrective Action (CA) Code in the CA column Codes:R = Retested within rangeO = Retest still outsideS = New test strips or lotC = New controlsT = Adjusted technique to reflect procedureM = QC/strip lot not matchedE = Expiration dates exceededP = Contacted POCT Coordinator
