Information on the Number and Cost of Diagnostic Test Services – PRIMARY CARE ONLY

DATA SET B: 01/04/2015 to 31/03/2016

Please note that this the current Financial Year

A CCG may receive\commission laboratory services from more than one laboratory provider.

  • If the CCG receives services from a single laboratory please complete section A (page 2).
  • If however the CCG receives services from multiple laboratories please copy and complete a section A for every laboratory provider. If you are unable to complete multiple “section As” then complete section A for your major laboratory provider.

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Section A (complete a copy of this for every laboratory providing these services)

Name of CCG: …………………………………………………………

Name of provider laboratory: …………………………………………………………

Period of interest: 01/04/2015 to 31/03/2016(inclusive). Financial year 2015-2016.

Please supply the unit price you will pay for:

Investigation / Unit Cost 2015 - 2016
£0.00
HbA1c
(glycated haemoglobin)
Glucose
(plasma/serum, to include fasting and non-fasting)
Renal Profile / Urea & Electrolytes
Enter the profile data here ->
If known, please indicate the tests in the renal profile:
Sodium yes/no
Potassium yes/no
Chloride yes/no
Bicarbonate yes/no
Urea yes/no
Creatinine yes/no
Or,if the tests are requested individually, please list below and supply the number, cost etc here for
Plasma/serum potassium ->
Plasma/serum creatinine -> / ……?….
……?…..
……?…..
Lipid profile
(to include fasting, non-fasting and “diabetic” lipid profiles)
Urine albumin (ACR)
(also known as microalbumin, urine albumin creatinine ratio, ACR)
Investigation / Unit Cost 2015 - 2016
£0.00
Thyroid Function Tests
(could be singleton TSH or TSH plus freeT4) Please indicate if known:
TSH only ……….. (yes/no)
TSH and other test(s) ……… (yes/no)
Liver Function Test (LFTs), Liver Profiles
Enter the profile data here ->
If known, please indicate the tests in the liver profile:
ALT yes/no
AST yes/no
Total bilirubin yes/no
Alkaline phosphatase yes/no
Total protein yes/no
Albumin yes/no
Globulin yes/no
GGT (gamma GT) yes/no
Or, if the tests are requested individually, please list below and supply the number, cost etc here ->
Test 1…..
Test 2….
Cont… / ……?….
……?…..
……?…..
Ferritin

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