Rapid Cards

Product Name:

Hospital/Clinic Lab Name:

State:

City:

Contact Number:

Lot. No.:

Name of Distributor:

Date of Purchase:

Quantity Purchase:

Quantity in Stock:

Description of Complaint:

Is Complaint Sample Repeated After Centrifugation:

Yes No

Result of Repeated Test:

Is Complaint Sample Checked With Any Other Company:

Yes No

Please Attach Images Of Rapid & Reading Of ELISA:

Result on Competitor Kit:

is Complaint Verified By Confirmatory Test:

Yes No

Result on Confirmatory Test:

Positive Negative

Is Complaint Sample Available in Lab:

Yes No