Get Survey User's Guide: Nursing Home Survey On Patient ... - Ahrq - Ahrq

This guide provides clear, step-by-step instructions for completing the Survey User's Guide related to the nursing home survey on suspected urinary tract infections. Designed for ease of use, it serves as a comprehensive resource for healthcare professionals engaging with the document.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to access the document and open it in the editable format.
2. Fill in the date and time of the report at the top of the form.
3. Enter the nursing home name and resident's name as specified.
4. Provide the resident's date of birth and details of the physician, nurse practitioner, or physician assistant including their name and contact information.
5. Indicate how the submission is being made (phone, fax, in person, or other) and provide details accordingly.
6. In the 'Situation' section, check the relevant vital signs field and enter the values.
7. For the 'Background' section, report any active diagnoses or symptoms related to bladder or kidney conditions, and indicate if the resident has an indwelling catheter, is on dialysis, or is incontinent.
8. Complete the medication allergies section, detailing any allergies and whether the resident is on .
9. In the 'Assessment' section, check all applicable boxes regarding criteria for antibiotic initiation based on the resident’s condition.
10. In the 'Request for Physician/NP/PA Orders' section, specify the requested actions including diagnostic tests and any necessary medications.
11. Ensure the physician or designee signs and dates the form before submission.
12. Once all fields are filled, save your changes, and utilize options to download, print, or share the completed form as necessary.

Complete your nursing home survey forms online today.