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WSLH PT roficiency esting Calibration Verification/ Linearity Products Products provided in partnership with: www.wslhpt.org 800-462-5261 PTService@slh.wisc.edu

General Chemistry Ammonia/Ethanol - 5 x 2mL liquid samples containing: Ammonia Ethanol Bilirubin For Roche Systems - 5 x 1mL freeze-dried samples containing: Direct Bilirubin Total Bilirubin General Chemistry - 10 x 5mL freeze-dried samples containing: Albumin Chloride Iron Potassium Alkaline Phosphatase Cholesterol Lactate Sodium ALT (SGPT) CO2 LDH TIBC Amylase Creatinine Kinase (CK) LDL Cholesterol Total Protein AST (SGOT) Creatinine Lipase Triglycerides Bilirubin (Total & Direct) Gamma - GT Magnesium Uric Acid BUN Glucose Osmolality Calcium HDL Cholesterol Phosphorus Order # K712M-5 *Roche Systems Users: Order# 881M-5 Order # K886M-5 Order # K701M-5 *Beckman AU Users: Order# K820M-5 *For Roche Systems, see K880M-5 (below) General Chemistry - For Roche Systems - 10 x 5mL freeze-dried samples containing: Order # K880M-5 Albumin BUN Creatine Kinase (CK) LDH Sodium Alkaline Phosphatase Calcium Gamma - GT Lipase Total Bilirubin ALT (SGPT) Chloride Glucose Magnesium Total Protein Amylase CO2 Iron Phosphorus Uric Acid AST (SGOT) Creatinine Lactate Potassium ISE - 5 x 5mL liquid samples containing: Chloride Potassium Sodium Lipids - 5 x 2mL freeze-dried samples containing: Apo A Cholesterol LDL Cholesterol Apo B HDL Cholesterol Triglycerides UIBC - 5 x 1mL freeze-dried samples. Order # K726M-5 Order # K709M-5 *Roche Systems Users: Order# K882M-5 Order # K732M-5 Cardiac BNP (High) - 5 x 1mL freeze-dried samples containing: NT-ProBNP BNP (Low) - 5 x 1mL freeze-dried samples containing: NT-ProBNP Order # K713M-5 Order # K708M-5 BNP (Extended) - 5 x 1mL freeze-dried samples containing: NT-ProBNP BNP - 5 x 1mL freeze-dried samples containing: Order # K737M-5 *RAMP Users: Order # K888M-5 *Siemens Stratus Users: Order# K892M-5 BNP For Siemens Centaur - 5 x 1mL freeze-dried samples. Cardiac Markers - 5 x 1mL freeze-dried samples containing: CK-MB Myoglobin Troponin I Order # K803M-5 Order # K710M-5 *Siemens Centaur Users: Order # K804M-5 *Siemens Stratus Users: Order # K891M-5 *RAMP Users: Order # K887M-5

D-Dimer - 5 x 1mL freeze-dried samples. Homocysteine - 5 x 1mL liquid samples. hscrp - 5 x 1mL liquid samples. Order # K717M-5 *biomerieux VIDAS & minividas Users: Order # K845M-5 *Siemens Stratus Users: Order # K893M-5 *PATHFAST Users: Order # K883M-5 Order # K704M-5 *Siemens Centaur Users: Order# K801M-5 Order # K705M-5 Cardiac (Continued) ASO - 5 x 1mL liquid samples. Anemia For Siemens Centaur - 5 x 3mL freeze-dried samples containing: Cortisol Ferritin Folate Vitamin B12 Fertility For Siemens Centaur - 5 x 3mL freeze-dried samples containing: Estradiol hcg Progesterone Testosterone FSH LH Prolactin Order # K721M-5 Order # K809M-5 Order # K808M-5 Immunoassay Immunoassay - 10 x 5mL freeze-dried samples containing: Set 1: Folate Prolactin TSH Set 2: Cortisol FSH Testosterone Vitamin B12 Free T3 Digoxin hcg Total PSA Free T4 Estradiol LH Total T3 Ferritin Progesterone Total T4 Immunoassay For Abbott Architect i Series - 5 x 5mL freeze-dried samples containing: CEA Free PSA Progesterone Total PSA Ferritin FSH Prolactin TSH Folate LH Testosterone Vitamin B12 Order # K714M-5 Order # K833M-5 Procalcitonin Linearity For biomerieux Vidas & minividas - 5 x 1mL freeze-dried samples. Order # K841M-5 Procalcitonin Method Validation For biomerieux Vidas & minividas -25 x 1mL freeze-dried samples. RF/CRP - 5 x 1mL liquid samples containing: CRP RF Order # K842M-25 Order # K720M-5 T-Uptake Calibration Verification For Tosoh AIA - 5 x 1mL samples. Thyroid For Abbott Architect i Series - 10 x 2mL freeze-dried samples containing: Set 1: Set 2: Total T3 Total T4 Free T3 Free T4 Order # K851M-5 Order # K832M-5 Thyroid For Siemens Centaur - 10 x 3mL freeze-dried samples containing: Set 1: Total T4 Set 2: Total T3 TSH Free T3 Free T4 Order # K807M-5

Immunoassay (Continued) Tumor Markers - 10 x 1mL freeze-dried samples containing: AFP CA 19-9 CEA Set 2: CA 125 CA 27-29 (BR) Total PSA CA 15-3 Free PSA Tumor Markers For Siemens Centaur - 5 x 1mL freeze-dried samples containing: Set 1: CA 125 CA 27-29 (BR) Total PSA Set 2: AFP CA 19-9 CEA CA 15-3 Vitamin D - 5 x 2mL liquid samples. Order # K719M-5 Order # K805M-5 Order # K729M-5 *Roche Systems Users: Order# K885M-5 Immunology Protein - 5 x 2mL liquid samples containing: Alpha-1-Antitrypsin Complement C4 Immunoglobulin G (IgG) Total Protein Complement C3 Immunoglobulin A (IgA) Immunoglobulin M (IgM) Transferrin (TRF) Order # K702M-5 Diabetes Beta-Hydroxybutyric Acid - 5 x 1mL liquid samples. Blood Glucose (DROP) - 5 x 1mL liquid samples. Glycohemoglobin A1c - 5 x 0.5mL freeze-dried samples. Order # K728M-5 Order # K736M-5 Order # K703M-5 Urine Chemistry Microalbumin/Microprotein - 5 x 2mL liquid samples. Urine/Fluids Chemistry - 10 x 3mL freeze-dried samples containing: Set 1: Set 2: Creatinine Microprotein Osmolality Urea Nitrogen Amylase Glucose Potassium Phosphorus Uric Acid Calcium Magnesium Sodium Chloride Microalbumin Order # K722M-5 Order # K723M-5 Therapeutic Drug Monitoring TDM - 5 x 5mL freeze-dried samples containing: Acetaminophen Gentamicin Phenytoin Theophylline Vancomycin Carbamazepine Lithium Quinidine Tobramycin Digoxin Phenobarbital Salicylate Valproic Acid TDM For Siemens Centaur - 5 x 5mL freeze-dried samples containing: Carbamazepine Gentamicin Phenytoin Tobramycin Vancomycin Digoxin Phenobarbital Theophylline Valproic Acid Order # K707M-5 Order # K802M-5 Blood Gas Blood Gas Calibration Verification - 15 x 2mL liquid samples containing: BUN Glucose pco2 Potassium Chloride Ionized Calcium ph Sodium Creatinine Lactate po2 Order # K727M-5

Calibration Verifi cation/linearity Products Price List Product Name Order # Price* Product Name Order# Price* Ammonia/Ethanol K712M-5 $343.00 ASO K721M-5 $343.00 Ammonia/Ethanol (Roche Systems) K881M-5 $343.00 Anemia (Siemens Centaur) K809M-5 $107.00 General Chemistry Bilirubin (Roche Systems) K886M-5 $51.00 General Chemistry K701M-5 $343.00 General Chemistry (Beckman AU) General Chemistry (Roche Systems) K820M-5 $343.00 K880M-5 $292.00 ISE K726M-5 $118.00 Lipids K709M-5 $343.00 Lipids (Roche Systems) K882M-5 $343.00 UIBC K732M-5 $343.00 BNP (High) K713M-5 $343.00 Fertility (Siemens Centaur) K808M-5 $163.00 Immunoassay K714M-5 $343.00 Immunoassay (Abbott Architect i Series) Procalcitonin Linearity (biomerieux Vidas & minividas) Procalcitonin Method Validation (biomerieux Vidas & minividas) K833M-5 $303.00 K841M-5 $343.00 K842M-25 $702.00 RF/CRP K720M-5 $343.00 T-Uptake Calibration Verification (Tosoh AIA) Thyroid (Abbott Architect i Series) K851M-5 $80.00 K832M-5 $50.00 Thyroid (Siemens Centaur) K807M-5 $73.00 Immunoassay BNP (Low) K708M-5 $343.00 Tumor Markers K719M-5 $518.00 Cardiac BNP (Extended) K737M-5 $343.00 BNP (RAMP) K888M-5 $343.00 BNP (Siemens Stratus) K892M-5 $343.00 BNP (Siemens Centaur) K803M-5 $343.00 Cardiac Markers K710M-5 $343.00 Cardiac Markers (Siemens Centaur) Cardiac Markers (Siemens Stratus) K804M-5 $343.00 K891M-5 $343.00 Cardiac Markers (RAMP) K887M-5 $343.00 D-Dimer K717M-5 $389.00 Tumor Markers (Siemens Centaur) K805M-5 $518.00 Vitamin D K729M-5 $148.00 Vitamin D (Roche Systems) K885M-5 $148.00 Protein K702M-5 $343.00 Beta-Hydroxybutyric Acid K728M-5 $343.00 Blood Glucose (DROP) K736M-5 $125.00 Glycohemoglobin A1c K703M-5 $343.00 Microalbumin/Microprotein K722M-5 $343.00 Urine/Fluids Chemistry K723M-5 $236.00 Immunol. Diabetes Urine Chemistry D-Dimer (biomerieux VIDAS & minividas) K845M-5 $389.00 D-Dimer (Siemens Stratus) K893M-5 $389.00 TDM K707M-5 $343.00 TDM (Siemens Centaur) K802M-5 $343.00 TDM D-Dimer (PATHFAST) K883M-5 $389.00 Blood Gas Calibration Verification K727M-5 $343.00 Blood Gas Homocysteine K704M-5 $343.00 Homocysteine (Siemens Centaur) K801M-5 $343.00 *Prices are valid on orders placed through December 31st, 2018 hscrp K705M-5 $343.00

www.wslhpt.org 2601 Agriculture Drive, Madison, WI 53718 (800) 462-5261 FAX (608) 265-1111 Linearity Sample Order Form Today s Date Date shipment needed by: Identification Information WSLH PT ID# CLIA ID: D Check box if application in progress and CLIA ID# not yet received Contact Information Of Person Completing This Form Facility Name Phone Contact Name Email Demographic Information Fill in ONLY if new customer or information is different than PT enrollment. Shipping Information Facility Name Street Address Contact Name Apt, Suite, Bldg. (optional) City State/Province/Region Postal/Zip Code Country Phone Fax Email Billing Information Check here if same as ship to information Facility Name Street Address Contact Name Apt, Suite, Bldg. (optional) City State/Province/Region Postal/Zip Code Country Phone Fax Email Order Information It will be necessary to refer to the Linearity Products flyer while completing this portion. Product Order# Quantity Price Per Set Total Price Indicate Method Of Payment Bill Me: PO# to reference on invoice VISA/MC: If you wish to pay by credit card, please wait for your invoice for instructions. Subtotal Shipping Charge $50.00 Total Fax forms to: 608-265-1111 Email forms to: PTService@slh.wisc.edu Questions: 800-462-5261 x0