IntroductionWe organized the 4th Mongolian External Quality Assessment Survey (MEQAS) for Clinical Chemistry testing on basis of the Cooperation agreement between the Ministry of Health Mongolia and Sysmex Corporation in the establishment of the clinical chemistry external quality control, and reference laboratory system in 2011-2013.MethodIn 4th survey, the following survey material we used: Mtrol 1 (Level 1), Mtrol 2 (Level 2). To evaluate participant laboratories we divided into peer groups: full automated analyzer, semi automated analyzer and also divided analyzers by manufacturers and calculate standard deviation index (SDI), precision index (PI). We used absolute evaluation and scoring methods.ResultsThe number of participant laboratories increased in number by 133 instruments from 3rd MEQAS and became 139 instruments, but there were no significant improvements in most all items. The comparison transition of CV 4th MEQAS to 3rd MEQAS we found that there were not much differences between before the 3rd and 4th MEQAS, except some items like total protein, Lactate dehydrogenase (P-L), γ-Glutamyl transferase, potassium, bilirubin direct in which CV % have decreased in number by about 3% from 10% in both levels. We found out the difference results between full automated analyzer, semi automated analyzer groups and manufacturer analyzers and methods in both levels. To improve the results in the future to establish national standards for the reporting units and suggested reagents for clinical chemistry tests, which will be the directions for standardization.