PAP PT Appeal Submission
PAP PT Appeal Submission
For Use Only with Unacceptable PAP PT Scores (Less than 90%)
Note: All fields are required and must be completed before submission.
Participant Name:
Proficiency Testing Registration Number PTR:
Kit Number:
Laboratory CAP Number:
Testing Site CLIA Number:
Testing Session (date):
Case Number:
Slide Type:
Conventional
ThinPrep®
SurePath™
Slideset Number:
Detailed description of the challenge and defense of diagnostic appeal:
Your name:
Address:
Institution:
City:
CAP #:
State:
E-mail:
Zip:
Telephone:
