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1. What is your CMPT laboratory number
2. Method used to determine if this sample contains a Carbapenemase Resistant Bacteria
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3. Result for Sample A - CPEscreen1
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4. Genus of Positive CPE in Sample A - CPEscreen1
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5. Result for Sample B - CPEscreen2
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6. Genus of Positive CPE in Sample B - CPEscreen2
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4
Reviewer Response Page
7. What is your name?
8. In your opinion is this response form complete enough for addressing the presence or
absence of KPC in a rectal swab sent for screening?
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9. In your opinion would it be improved by changing any of the text?
10. In your opinion would we benefit from addition questions or information?
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11. Do you have any additional comments?