Form Cdc 73.60 - C Control Strain Susceptibility Testing Page 2
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2Coding Instructions
Regional Laboratory Codes:
EMO
Atlanta — Emory University
AUS
Austin — Texas Department of State Health Services
BID
Boston — Beth Israel Deaconess Medical Center
UAB
Birmingham — University of Alabama at Birmingham
UWA
Seattle — University of Washington
ß-Lac:
(ß--lactamase test) Check the appropriate box.
1 = positive
2 = negative
Pen:
(penicillin MIC)
Valid dilutions: 0.008, 0.015, 0.03, 0.06, 0.125, 0.25, 0.5, 1.0, 2.0, 4.0, 8.0, 16.0, 32.0, 64.0
Tet:
(tetracycline MIC)
Valid dilutions: 0.06, 0.125, 0.25, 0.5, 1.0, 2.0, 4.0, 8.0, 16.0, 32.0, 64.0
Gen:
(gentamicin MIC)
Valid dilutions: 1.0, 2.0, 4.0, 8.0, 16.0, 32.0
Cfx:
(cefixime MIC)
Valid dilutions: 0.002, 0.004, 0.008, 0.015, 0.03, 0.06, 0.125, 0.25, 0.5, 1.0, 2.0
Cro:
(ceftriaxone MIC)
Valid dilutions: 0.001, 0.002, 0.004, 0.008, 0.015, 0.03, 0.06, 0.125, 0.25, 0.5, 1.0, 2.0
Cip:
(ciprofloxacin MIC)
Valid dilutions: 0.001, 0.002, 0.004, 0.008, 0.015, 0.03, 0.06, 0.125, 0.25, 0.5, 1.0, 2.0, 4.0, 8.0, 16.0
Azi:
(azithromycin MIC)
Valid dilutions: 0.008, 0.015, 0.03, 0.06, 0.125, 0.25, 0.5, 1.0, 2.0, 4.0, 8.0, 16.0, 32.0, 64.0, 128.0, 256.0
Opt:
(optional agent)
Date tested:
(mm/dd/yyyy)
Enter month, day, and year of isolate testing.
CDC 73.60-C Rev 11-2015 (BACK)
Gonococcal Isolate Surveillance Project / Form 3: Control Strain Susceptibility Testing
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