PNW Patient Safety Notice & Receipt Acknowledgment

PNW Patient Safety Notice & Receipt Acknowledgment

Confirm you received the Nov. 5, 2026 notice and were provided access to the CRAB fact sheet.
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Read the patient letter and CRAB fact sheet
Patient safety update — November 5, 2026

The most recent positive MDRO report among patients receiving care from PNW Wound Specialist was dated October 23, 2026.

Please review both documents before confirming receipt:

Open or download the patient letter and CRAB fact sheet (3-page PDF)

Open the Washington DOH CRAB fact sheet separately (PDF)

Receiving this notice does not mean you have CRAB or an infection. For help, a paper copy, or questions call 509-209-9033. This form is not monitored for emergencies.
Screening is coordinated with SRHD. This acknowledgment does not request or consent to screening.
Patient full name

First NameLast Name
Who is completing this form?
Representative name and relationship to patient
Email
example@example.com
Phone number
Please enter a valid phone number.Format: (000) 000-0000.
Receipt acknowledgment — This records receipt only, not consent to screening or treatment.
Follow-up requests
Best time to call
Should be Empty: