Acknowledgement of Advisory Notice Receipt Form – GI Panel

*All Fields are Required

Name of Institution*
Job Title*
First Name*
Last Name*
Phone*
Email*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
I have read and acknowledged the receipt of the ADVISORY NOTICE URGENT: MEDICAL DEVICE RECALL (bioMérieux FSCA 5812) Increased Risk of False Positive Norovirus Results with the BIOFIRE® FILMARRAY® Gastrointestinal (GI) Panel (RFIT-ASY-0116 and RFIT-ASY-0104)*
- Yes
- No
I have implemented the actions as indicated in the attached Notices.*
- Yes
- No
Electronic Signature*
Date*