CMPT03/H/10/2009: Specimen and Microbial Identification
Report Form
Laboratory
Name:
Laboratory
No:
Specimen
Number:
Source/Site:
Microbial
Identification:
Comments:
Date
Received:
Date
Reported:
Check all that apply
This laboratory does not process this type of specimen.
This sample would normally be submitted to another laboratory for additional investigation.
Isolation Precaution: infection control, ward or designate would normally be notified.
A notification to Public Health would normally be submitted.
Please complete the following MICROBIAL IDENTIFICATION TEST INFORMATION
Gram stain morphology:
Hemolysis on 5% sheep blood agar:
Atmosphere for optimal growth:
Colonial
morphology:
Primary
Identification System Used: Indicate
by n Inclusion
or exclusion of
a product name does not imply product endorsement or
rejection by CMPT. Please record result for single tests
(shown below) performed on this isolate.