Page 1 of 2 Document No: INS-SE-52 Version No: 12 RS38-FVDengue Printed: 15-Jan-19, 9:59 AM Flavivirus – Dengue Fever Serology Please print the document labelled ‘Clinical Notes & Test Instructions’ and enter your results via myQAP. Kit Information Please supply kit lot number and expiry date If you have changed kits since the last RCPAQAP Serology survey, OR have not previously supplied your kit details to the RCPAQAP Serology, please provide us with your new kit details DO NOT FILL IN DETAILS FOR TESTS IF RESULTS ARE NOT INCLUDED Test for example, IgG, IgM, Total Ab, NS1 Ag, NS1/IgG/IgM Combined Method for example, EIA, HAI, IFA, ICT Please write expiry date as Mmm/yy example, Nov 19 Test Method Lot Number Expiry Date Test Results Units – for example, S/CO, titre Cut-off value is the absolute value that designates the cut-off point below which is negative or equivocal and equal to or above is positive. Do not use >, ≥, , < for cut-off value. Test value – for the purposes of the QAP, titre is defined as the inverse of the end-point dilution – for example, a dilution of 1/64 or 1:64, is a titre of 64. Please express the titre in this manner and do not write the dilution. Test result - (Neg = negative, Equ = equivocal, Pos = positive). Enter Not Tested if Not Tested. Enter N/A (not applicable) if any of the above do not relate to your test Specimen No. ___A Specimen No. ___B Test Units Cut-off Value Result Value Result Participant No: _ _ _ _ _ Survey No: V___:20___