Object of the test* pharmaceutical substance/raw material non-pharmaceutical substance mixture of chemical substances mixture of natural - plant derived substances medical product medical device food supplement/food for special medical purposes probiotic plastics/containers other - (please indicate in the description below)
Object of the test (detailed description of the sample)*
Additional information about the sample* Specify, sample form (e.g. capsules, powder, syrup, herbal mixture, fabric, plastic tube, etc.), quality composition (mandatory for multicomponent samples), package size, sample size, etc.
Test objective* Assessment of compliance with Ph. Eur/norm requirements: one parameter multiple parameters Other than assessment of compliance with Ph. Eur/norm requirements. single parameter multiple parameters
Scope of testing* Which parameters or product characteristics are to be tested e.g.: determination of sub. x, in vitro cytotoxicity test, transmission of solution in xxx range - xxx, etc.
Test method* Pharmacopoeial/normative method (please indicate in the description below) supplied by the Client (please indicate in the description below) NIL's own (method to be proposed by expert based on information provided in the form)
Test method details/method* Complete only if pharmacopoeial / prescriptive method or indicated / supplied by the client is marked above. Specify the name of the method (e.g. type of analytical technique), the name and/or number of the monograph / standard.
Requirements for tested parameters* Specify requirements for tested parameters, i.e. specification range, declared value or expected value, e.g.: content of substance X 3.5-5.5 mg/tablet, declaration for substance X 250 mg/10 ml, requirements according to monograph no. xxx, etc. In the case of quantitative assays, information necessary to assess whether testing will be possible.
Expert report (preferred type)* only in Polish only in English in Polish and English one cumulative for all series/ batches separately for each series/batch
Contact information: Name*
Contact Information: Email address*
Contact Information: Phone number*
