Patient/QC Printout Log Sheet – Urine Test Strips

Date: ______________

Affix printed report from CLINITEK® Status Family of analyzers printouts in spaces provided:

Urine Test Strip	Control Information:
Test strip name:	Control level:
Lot number:	Lot number:
Expiration date:	Expiration date:

Patient/QC Printout Log Sheet – hCG Tests

Date: _______________

Affix printed report from Clinitek Status® Family of analyzers printouts in spaces provided:

CLINITEST hCG Test Cassette Information:	Control Information:
Lot number:	Lot number:
Expiration date:	Expiration date: