SECTION
C
38
Name of facility:
QUALITY CONTROL RECORD
Assure® Platinum Blood Glucose Monitoring System:
Assure Platinum Meter Serial # _______________________________
Unit ___________________________ Month/Year _________________
D
ate
S
ta
tion
/
S
hi
ft
O
p
er
at
or
In
it
ial
s
Tes
t S
tri
p
N
or
m
al
(
L
ev
el
1
) C
ont
ro
l R
ang
e
Hig
h
(
L
ev
el
2
) C
ont
ro
l R
ang
e
C
or
re
ct
iv
e
Ac
tion
(Y/
N
)
L
o
t #
E
xp.
D
ate
L
o
t #
E
xp.
D
ate
C
ont
ro
l
Ra
n
ge
C
ont
ro
l
R
esul
t
L
o
t #
E
xp.
D
ate
C
ont
ro
l
Ra
n
ge
C
ont
ro
l
R
esul
t