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* 1. Facility Name

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* 2. Facility Organization

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* 3. Provide the names of 2 hospitals which you would like to gain access to their Electronic Medical Record

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* 4. Which one of the 2 identified hospitals will you be/are you working with this month?

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* 5. I have identified the  point of contact (POC) who can grant permission to gain access to the EMR for this hospital.

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* 6. Verbal or written contact has been made with the POC

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* 7. A request for access has been made and/or a meeting has been set up to discuss the project further. (Check all that apply)

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* 8. Response to Request for EMR Access

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* 9. Facility and Hospital are:

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* 10. Facility has gained EMR access and is able to view at LEAST blood culture results

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