Get National Clostridium Difficile Enhanced Surveillance Form

Filling out the National Clostridium Difficile Enhanced Surveillance Form online can seem daunting, but with a clear understanding of each section, you can complete it with confidence. This guide will walk you through the necessary steps and important fields, ensuring that you provide accurate information.

Follow the steps to complete the form effectively.

1. Click the ‘Get Form’ button to obtain the National Clostridium Difficile Enhanced Surveillance Form and open it for editing.
2. Begin by providing the patient details. Input the patient ID, hospital code, sex, age, and date of birth. If applicable, indicate whether the patient was admitted to the hospital, and if so, specify the date of admission.
3. Next, identify the case type by selecting either 'New' or 'Recurrent.' Refer to the definitions provided in the form to make the correct selection.
4. In the isolate details section, fill in the specimen date and specimen ID. Indicate the origin of the specimen by selecting the appropriate option—whether it is from the current hospital, another hospital, a nursing home, a general practice, or marked as having no information available.
5. For the onset of C difficile infection (CDAD), select whether the onset was healthcare-associated or community-associated. Record the date of onset if known and specify the facility where the symptoms began if applicable.
6. Determine the origin of the C difficile infection (CDAD) by selecting the appropriate option. Ensure to check if it aligns with the definitions provided in this section.
7. Next, assess the severity of the case. Indicate if there was an ICU admission for CDAD treatment or if surgery (colectomy) was performed for complications.
8. Review all entries for accuracy. After ensuring the information is complete and correct, proceed to save your changes. You may then choose to download, print, or share the completed form as necessary.

Take the first step towards effective documentation by completing the National Clostridium Difficile Enhanced Surveillance Form online.