MEDICAL LABORATORIES HOSPITAL UNIVERSITI SAINS MALAYSIA REVIEW OF CONTRACTS

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1 HUSM/LCD/QP-22 MEDICAL LABORATORIES HOSPITAL UNIVERSITI SAINS MALAYSIA REVIEW OF CONTRACTS Prepared by: Assoc. Prof. Dr Rosline Hassan Approved by: Effective date:

2 MEDICAL LABORATORIES HOSPITAL UNIVERSITI SAINS MALAYSIA Page 1 of 8 REVIEW OF CONTRACTS Title: TABLE OF CONTENT Version 1 HUSM/LCD/QP-22 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 Effective Date

3 MEDICAL LABORATORIES HOSPITAL UNIVERSITI SAINS MALAYSIA Page 2 of 8 REVIEW OF CONTRACTS Title: RECORD OF AMENDMENT Version 1 HUSM/LCD/QP-22 Amendment 3 RECORD OF AMENDMENT VERSION NO. VERSION DATE DESCRIPTION OF AMENDMENT SIGNATURE OF APPROVAL Changes of version MS ISO 15189:2004 to new version MS ISO 15189: Transforming version 1 MS ISO 15189:2007 into electronic document web address: ISO 15189: (Effective date 29/04/2010) (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 Ammendment 2: Appendix 3: New form VERSION NO. AMENDMENT DATE DESCRIPTION OF AMENDMENT Document was reviewed on the SIGNATURE OF APPROVAL 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 Effective Date

4 MEDICAL LABORATORIES HOSPITAL UNIVERSITI SAINS MALAYSIA REVIEW OF CONTRACTS HUSM/LCD/QP-22 Title: RECORD OF REVIEW Page 3 of 8 Version 1 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 Effective Date

5 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 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 Effective Date

6 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 Issued Date Effective Date

7 MEDICAL LABORATORIES HOSPITAL UNIVERSITI SAINS MALAYSIA REVIEW OF CONTRACTS HUSM/LCD/QP-22 Page 6 of 8 Title: PROCEDURE Version 1 7. PROCEDURE No Activity Responsibility 7.1 Identify the customers Customer requesting for laboratory test will be identified either as internal or external customer For both customers, the tests and related information are made available by medical laboratories. LD 7.2 Prepare contract details For internal customers The arrangement may be in the form of memorandum, manual, circular, letter, minutes of meeting LD/QM 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 7.3 Upon receipt of contract documents from customer proceed with the approval from lab director 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 QM/TM LD 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 Follow the flowchart as in Appendix : 4a and 4b 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 TM/SO/MLT TM/SO/MLT TM/SO/MLT Prepared by Approved by Assoc. Prof. Dr Rosline Hassan Effective Date

8 MEDICAL LABORATORIES HOSPITAL UNIVERSITI SAINS MALAYSIA REVIEW OF CONTRACTS HUSM/LCD/QP-22 Page 7 of 8 Title: RECORD Version 1 8. RECORD No. Record Retention of Records 1. Records of contract documents At least 5 years 2. Records of contract amendment At least 5 years Prepared by Approved by Assoc. Prof. Dr Rosline Hassan Effective Date

9 MEDICAL LABORATORIES HOSPITAL UNIVERSITI SAINS MALAYSIA Page 8 of 8 REVIEW OF CONTRACTS HUSM/LCD/QP-22 Title: FLOWCHART Version 1 9. FLOWCHART Identify the customer Prepare contract details No Agreement between client and respective Medical Laboratory Reject with explanation Yes Proceed to tests Despatch results to customer Acknowledge to Unit Kewangan HUSM Prepared by Approved by Assoc. Prof. Dr Rosline Hassan Effective Date

10 Appendix 1 HOSPITAL UNIVERSITI SAINS MALAYSIA KUBANG KERIAN, KELANTAN Tel: (General Line) Fax: 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 :

11 Appendix 2 HOSPITAL UNIVERSITI SAINS MALAYSIA KUBANG KERIAN, KELANTAN Tel: (General Line) Fax: REGISTRATION FORM FOR LABORATORY SERVICE Ref No: Hospital: Tel: Fax: Address : Name of Medical Laboratory, HUSM: Date : Type of Test Requested : 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 :

12 Appendix 3 CHECK LIST FOR REVIEW OF CONTRACT Name of Medical Laboratory Requesting officer:. Date of request: Please tick ( ) at relevant section: Institution: Type of tests requested : Verbal: 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 :

13 Appendix 4a CARTA ALIRAN MAKMAL (DIURUSKAN OLEH USAINS TECH SERVICES SDN. BHD.) Organisasi/Hospital/Individu Borang yang tidak lengkap 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 TAMAT

14 Appendix 4b CARTA BAYARAN PERKHIDMATAN USAINS Organisasi / Hospital / Individu Terima keputusan dari makmal berkenaan beserta inbois dari Usains Tidak membuat pembayaran 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 Kubang Kerian Kelantan Account No. : CIMB Bank Tindakan susulan: Penyata Akaun, Panggilan Telefon Sekiranya pembayaran secara Bank in, EFT atau IBG, sila hantar pos/fax butiran yang berkenaan Tel : / 6958 Fax : Pengesahan bayaran oleh pihak Usains Tindakan Undang- Undang Pihak Usains akan mengeluarkan resit rasmi dan akan dipos atau difax kepada pihak berkenaan TAMAT

Appendix 5: Husm/Kew/BUM/06 BORANG UJIAN MAKMAL UNIT KEWANGAN HOSPITAL UNIVERSITI SAINS MALAYSIA 16150 KUBANG KERIAN, KELANTAN RUJUKAN DARIPADA / KEPADA : NAMA PESAKIT : WAD/UNIT : NO.

15 Appendix 5: Husm/Kew/BUM/06 BORANG UJIAN MAKMAL UNIT KEWANGAN HOSPITAL UNIVERSITI SAINS MALAYSIA KUBANG KERIAN, KELANTAN 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: Tujuan: Sebab-sebab perlu dihantar keluar : Sebab-sebab perlu dihantar keluar : Jenis-jenis Ujian : Anggaran setiap sampel : Jenis-jenis Ujian : Anggaran setiap sampel : Tandatangan Pemohon : (Ketua Unit/Jabatan/Penyelaras) Tandatangan Pemohon : (Ketua Unit/Jabatan/Penyelaras) Kelulusan Pengarah : Kelulusan Pengarah : Tandatangan : Tandatangan : Tarikh : 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.

16 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 :

MEDICAL LABORATORY HOSPITAL UNIVERSITI SAINS MALAYSIA

MEDICAL LABORATORY HOSPITAL UNIVERSITI SAINS MALAYSIA HUSM/LCD/QP-21 MEDICAL HOSPITAL UNIVERSITI SAINS MALAYSIA EXAMINATION BY REFERRAL : : Effective Date: 01.11.2010 Page 1 of 8 Title: TABLE OF CONTENTS Version 2 TABLE OF CONTENTS No. Index Page 1. Table