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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:
Slideset Number:
Detailed description of the challenge and defense of diagnostic appeal:
Your name: Address:
Institution: City:
CAP #: State:
E-mail: Zip:
Telephone: