INDIAN ACADEMY OF CYTOLOGISTS

EQA PROGRAMME 2018

REGISTRATION / RENEWAL ______

  1. NEW REGISTRATION / RENEWAL of REGISTRATION (Highlight one)
  1. Previous Registration No. (if Renewal):
  2. Name in Full and Designation:
  1. E-mail i.d :
  2. Contact Mobile No.
  3. Name of Laboratory:
  1. Complete postal address with pincode:

……………………………………………………………………………………

……………………………………………………………………………………

  1. Nature of your lab (Highlight one): Multispeciality hospital / Stand-alone laboratory / Medical college / Institute / Corporate lab
  2. Cytopathology Annual Workload (in previous year):

FNAC:

Exfoliative cytology:

Cervical cytology:

  1. No. of Staff in Cytopathology Laboratory:
  2. Laboratory Accreditation NABL / IAC / Other (Specify)
  1. EQA Registration Fee:

A. Txn Ref No……………………………..Date:

Payment by NEFT / RTGS

Bank Account details:

Account name: Indian Academy of Cytologists

Account no.10242308061

State Bank of India, Parel Branch, Mumbai

IFSC code: SBIN0001884

B. Demand draft to be made in name of Indian Academy of Cytologists, payable at MUMBAI

Demand Draft number: Date:

Bank:

Mail your D/d to:

Dr. Radhika Srinivasan,

EQA Chairperson

Department of Cytology & Gynec. Pathology,

Research A Block, 4th floor,

PGIMER, Chandigarh – 160012.

Tel:9914208116

Signature(Append Digital signature)

Date

Note: If you are unable to e-mail me using your digital signature, you could print-out the filled in form and sign it, scan it and mail it to me in PDF format preferably.

Instructions for EQA 2018:

  1. Registration is mandatory for ALL laboratories to participate in the EQA programme.
  2. Only accredited laboratories are allowed to participate in this program
  3. The Registration fee is Rs.5000/= for New Registrations which is non-refundable and includes the first year annual participation fee.
  4. Subsequently, for all laboratories there will be an Annual Renewal Fee of Rs.2000/=.
  5. Payment mode: NEFT is preferred. Alternate option: Demand draft
  6. ALL Communication will be with this registered E-mail i.d only.
  7. Please save this in Word file format as a Read-only file in the short form of your lab’s name, place, followed by year - Eg., PGI CHD-2018; TMH MUM-2018
  8. e-mail this form to :
  1. Last date for Registration is 26th February2018
  1. An acknowledgment by e-mail will be sent to you in March 2018.

For any query contact -

Dr. Radhika Srinivasan,

EQA Chairperson

Department of Cytology & Gynec. Pathology,

Research A Block, 4th floor,

PGIMER, Chandigarh – 160012.

Tel:9914208116

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