CPO Surveillance Forms 2017 – Appendices C-G combined
A ppendix C – Surveillance Form for Carbapenemase- Producing Organisms (CPO) Identified in Acute Care Facility Once completed, please send i t to PICNet at picnet@phsa.ca (cc Guanghong.han@phsa), or fax 604-8 75-4373 1 U nique Identifier – assigned by BCCDC Public Health Laboratory (PHL) _____________________________ 2 Patient’s status Inpatient Haemodialysis clinic patient Other , please specify ___________________________________ 3 Date of admission or visit (dd/mmm/yyyy) __________________________ 4 Name of...
Type: Media