PIN NUMBER: (For existing Participants only) If you are a LABORATORY and wish to participate in Blood grouping and typing exercises ONLY Select Program A Blood grouping and typing, Direct Coombs and Indirect Coombs Test Select Program B If you are a BLOODBANK and wish to participate in Blood grouping and typing, Direct Coombs & Indirect Coombs Test, Compatibility Test Select Program C grouping and typing , Direct Coombs & Indirect Coombs Test, Compatibility Select Program D Testing , Antibody Screening & Antibody Identification Transfusion Transmissible Infections Screen Module (serology HIV, HBV, HCV, Select Program E – Syphilis and malaria (This is in addition to Program C or D) –smear) * IMPORTANT: If you do not participate in any of the individual parameters in any program, please do not tick the option. You will be evaluated and marked for all selected options. Parameters My Cost Tick (√) to (You should tick only the parameters you actually Program Indicate Pricing perform and wish to be evaluated for) Participation Program A Blood Grouping and Typing Rs. 1800.00 OR Blood Grouping and Typing Program B Rs. 2300.00 Direct Coombs and Indirect Coombs test Laboratories OR Blood Grouping and Typing Program C Direct Coombs and Indirect Coombs test Rs. 2400.00 Compatibility test OR Blood Grouping and Typing Direct Coombs and Indirect Coombs test Rs. 3000.00 Program D Compatibility test Banks Antibody Screening Antibody Identification Transfusion Transmissible Infections Screen Program E Module (serology HIV, HBV, HCV, Syphilis and Rs. 3000.00 – malaria –smear) Donor haemoglobin Screen Rs. 500.00 TOTAL Total Charge for blood Banks (C+E) or (D+E) This form is to be returned along with yourregistrationpapersfor2018.Please retain a photocopy for your records. Payment will accepted only as Demand Draft favoring Treasurer CMC Vellore Association (CMCEQAS)” “The Name: Signature Date Seal:
PIN NUMBER: (For existing Participants only) If you are a LABORATORY and wish to participate in Blood grouping and typing exercises ONLY Select Program A Blood grouping and typing, Direct Coombs and Indirect Coombs Test Select Program B If you are a BLOODBANK and wish to participate in Blood grouping and typing, Direct Coombs & Indirect Coombs Test, Compatibility Test Select Program C grouping and typing , Direct Coombs & Indirect Coombs Test, Compatibility Testing , Antibody Screening & Antibody Identification Select Program D Transfusion Transmissible Infections Screen Module (serology – HIV, HBV, HCV, Syphilis and malaria –smear) (This is in addition to Program C or D) Select Program E * IMPORTANT: If you do not participate in any of the individual parameters in any program, please do not tick the option. You will be evaluated and marked for all selected options. Program Parameters (You should tick only the parameters you actually perform and wish to be evaluated for) Tick (√) to Indicate Participation Pricing My Cost Laboratories Program A Blood Grouping and Typing Rs. 1800.00 OR Program B Blood Grouping and Typing Rs. 2300.00 Direct Coombs and Indirect Coombs test OR Banks Program C Blood Grouping and Typing Rs. 2400.00 Direct Coombs and Indirect Coombs test Compatibility test OR Program D Blood Grouping and Typing Rs. 3000.00 Direct Coombs and Indirect Coombs test Compatibility test Antibody Screening Antibody Identification Program E Transfusion Transmissible Infections Screen Module (serology – HIV, HBV, HCV, Syphilis and malaria –smear) Rs. 3000.00 Donor haemoglobin Screen Rs. 500.00 TOTAL Total Charge for blood Banks (C+E) or (D+E) This form is to be returned along with yourregistrationpapersfor2018.Please retain a photocopy for your records. Payment will accepted only as Demand Draft favoring “The Treasurer CMC Vellore Association (CMCEQAS)” Name: Signature Date Seal:
CMCEQAS_Trans_mod_Pricin_schedule_2019.docx