Account Profile - Analysis Worksheet

JANT PHARMACAL CORPORATION

By completing the form below, we will be able to provide your lab with a simple presentation identifying where and how much savings can be realized by adopting our Clinical Chemistry, Hematology and Immunoassay Systems.

The presentation will show detailed reagent, control and calibration usage, as well as a simple pie-chart representing your costs and profits when using our systems.

This estimate is designed to reflect your laboratory testing needs by comparing your test volume with our system's running cost and reibursement rates. The more accurate the information you provide, the more accurate and meaningful the estimate.

Once you have submitted the completed form, you will be contacted by one of our laboratory specialists to provide you with a presentation and initial feasibility assessment.


Basic Information:


*required fields

Contact Name:*

Title:*

Company Name:*

Address:*

City:*

State/Province:*

Zip Code:*



Phone Number:*

Fax Number:*

Your E-Mail Address:*




HEMATOLOGY

Manufacturer/Model:

CBC's per Month:




CHEMISTRY

Manufacturer/Model:


Assay Panels:
( # per month )





Basic Metabolic:

Comp Metabolic:

Renal:

Lipid-Cardiac Risk:

Electrolytes:

Hepatic:


Individual Tests:





Na:

K:

CI:

ALB:

ALT:

AMY:

AST:

BUN:

CA:

CHOL:

CK:

CREA:

HDL-CL:

DBIL:

FE:

GGT:

GLU-H:

HDL-CI:

LDH:

LDL:

MG:

PHOS:

TBIL:

TP:

TRIG:

URIC:







IMMUNOCHEMISTRY

Manufacturer/Model:


Individual Tests:
( # per month )





TSH:

TT3:

T4:

FT4:

T Uptake:

AFP:

PSA:

CA 19-9:

CA 125:

27.29:

HgbA1c:

LH:

FSH:

Prolactin:

HCG:

bHCG:

Estradiol:

Progesterone:

Testosterone:

Ferritin:

Intact PTH:

Cystatin C:






 

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