Vidan PCT Seed Site Application

Contact Information

Name(Required)

First Last

Phone(Required)

Work Email(Required)

Facility Name(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

From the list, choose your PCT testing analyzer.(Required)

Other - PCT Testing Analyzer

From the list, choose your Clinical Chemistry analyzer.(Required)

Monthly PCT Test Volume

Under 50 tests

50 to 100 tests

100 to 150 tests

Over 150 tests

What is your average Turnaround Time (TAT) for PCT from the ER/ICU?

Less than 15 minutes

15 to 30 minutes

30 to 60 minutes

Greater than 60 minutes

Reducing our PCT turnaround time is an urgent priority for our lab.

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

How is PCT currently utilized in your hospital’s sepsis protocol? (Select all that apply)

Initial Risk Stratification (ER)

Sepsis Monitoring (ICU)

Antibiotic Stewardship

If it significantly saves money, would you consider a separate platform for Initial Risk Stratification and Sepsis Monitoring (if Antibiotic Stewardship is used in your sepsis protocol)?

Yes

N/A - We don't use Antibiotic Stewardship

What contractual limitations do you face with your current PCT platform?" (Select all that apply)(Required)

We are completely locked into an exclusive contract.

We can switch or share volumes only if we meet minimum volume commitments.

We can switch only if there is a verified performance/service failure.

We can switch at any time (no restrictive contract in place).

Other / Financial Penalty Applies

Other - Current PCT Platform

What is your facility’s current contract or acquisition cost per test for PCT?

Under $16.50 per test

$16.50 to $17.49 per test

$17.50 to $18.49 per test

$18.50 to $19.50 per test

Over $19.50 per test

What cost per test would justify volume-sharing, if a new PCT assay seamlessly integrated into your current chemistry analyzer and antibiotic stewardship protocols?

$14.50 to $16.00 per test

$12.50 to $14.49 per test

$10.00 to $12.49 per test

Under $10.00 per test

Would you like to be contacted on how to become a Procalcitonin FS Seed Site?

Yes

I need more time to decide