Patient name: Notifier details Date of birth: (Laboratory staff) Name and Surname: Specimen and testing details Age: AST results Specimen type: Designation: EUCAST MIC by E-test (µg/ml) Sex: Date specimen collected: Antibiotic / Breakpoint Hospital/Clinic: Address: Specimen laboratory number: Hospital number: Province: Disc diffusion (mm) Referring laboratory: Tel: Assays/tests used for ID confirmation (please list all): Antibiotic / Zone diameter (mm) Cell: Email: Assay/test used for AST: Alternative contact details: Patient details
Notifier details (Laboratory staff) Name and Surname: Designation: Hospital/Clinic: Address: Province: Tel: Cell: Email: Alternative contact details: Patient details Patient name: Date of birth: Age: Sex: Hospital number: Referring laboratory: Specimen and testing details Specimen type: Date specimen collected: Specimen laboratory number: Assays/tests used for ID confirmation (please list all): Assay/test used for AST: AST results EUCAST MIC by E-test (µg/ml) Antibiotic / Breakpoint Disc diffusion (mm) Antibiotic / Zone diameter (mm)
SOP-for-standardization-of-antimicrobial-testing-for-Neisseria-gonorrhoeae.docx