2022 New Lab Registration – CPQA-AQCP Forms

CPQA-AQCP Forms

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2022 New Laboratory Registration (all prices in CAD)

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All fields are required to submit a form unless indicated otherwise.

Laboratory Name

Of the representative submitting this subscription

Laboratory Phone Number

Mailing Address

Physical slides will be sent to this address.

Billing Address (if different than mailing address) (optional)

Please provide a billing contact name and email if possible.

Technologist Name

Technologist Email

Pathologist Name

Pathologist Email

2022 IHC Subscriptions Available: (optional)

PD-L1 (2 x $175; technical assessment only)

Class I (p63/AMACR/prostate basal epithelial keratin; $200)

H&E (2 x $100; assessment of fixation, mounting, sectioning and staining of YOUR OWN H&Es)

Calretinin ($200)

Chromogranin A ($200)

CK20 ($200)

HSV ($200)

MMR ($500)

ER ($200)

PR ($200)

HER2 Breast ($200)

c-Myc lymphomas ($200)

NTRK ($250)

Helicobacter Pylori ($200)

HMB45 ($200)

TTF-1 ($200)

Gastric HER2 (2 x $175)

ROS1 ($200)

p16 ($200)

p53 endometrial ($200)

p53 vulvar ($200)

BRAFV600E ($200)

CD117 ($200)

CD20 ($200)

ALK in NSCLC ($200)

Ki67 in breast ($200)

IDH1 R123H ($200)

ATRX ($200)

2022 ISH Subscriptions Available: (optional)

Gastric HER2 ISH ($25)

ALK ISH ($25)

Breast HER2 ISH ($25)

1p19q FISH (tentative; $25)

2022 Molecular EQA Subscriptions (tentative pending recruitment) (optional)

RET fusions ($500)

Other comments (optional)

If you run multiple clones for a biomarker (e.g. PD-L1) or separate assays (e.g. CEP17 and HER2 ISH), indicate so here and multiple slides can be sent if requested. Please note that optimization assistance for any above subscriptions is included (i.e. our samples can be used for EQA and validation).