Acknowledgement of Advisory Notice Receipt Form

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Name of Institution*
Job Title*
First Name*
Last Name*
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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 Correction (bioMérieux FSCA 5788) Potential for Candida tropicalis ‘Not Detected’ results when testing the MMQCI FilmArray BCID2 Control Panel M416 with the BIOFIRE® Blood Culture Identification 2 (BCID2) Panel.*
- Yes
- No
I have implemented the actions as indicated in the attached Notices.*
- Yes
- No
Electronic Signature*
Date*