CPO Surveillance Forms 2017
Appendix C – Surveillance Form for Carbapenemase- Produc ing Organisms (CPO) Identified in Acute Care Facility Once completed, please send it to PICNet at picnet@phsa.ca (cc Guanghong.han@phsa ), or fax 604-875-4343 1 Unique 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 <mark...
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