Attachment B
CLINICAL LABORATORY
Certification for Business Manager/Financial Supervisor's Point of
Care Testing
The costs for _________________(Name of Test)
Testing to be carried out using the _______________(Name of Instrument) at
___________________(location) will be paid for by the __________________ (Department,
etc.),
Hospital Cost Center # ______________. These costs are estimated as follows:
________ Instruments @ $_______
Total Capital Cost
$_____________
Reagents and disposables, cost per test:
_____________
Annual volume, patient tests:
_____________
Annual volume, repeats and wastage:
_____________
Annual volume, calibrators, control, proficiency testing:
_____________
Annual volume, total
_____________
Annual costs, reagent and disposables
$ _____________
Cost of control
_____________
Total
_____________
__________________________________________
Business Manager/Financial Supervisor Date
_____________________________________
Typed or printed name
