Get Infection Control Transfer Form - Cdph Ca

The INFECTION CONTROL TRANSFER FORM is an essential document that must accompany the patient during transfer to ensure proper infection control protocols are followed. This guide provides clear, step-by-step instructions for filling out the form online, tailored for users of all experience levels.

Follow the steps to complete the form accurately.

1. Click the ‘Get Form’ button to obtain the INFECTION CONTROL TRANSFER FORM and open it in your preferred online editor.
2. Begin by affixing any patient labels in the designated area at the top of the form. This ensures that the patient’s identity and relevant information is clearly marked.
3. Fill in the Demographics section with the patient’s/resident’s last name, first name, and date of birth, followed by their medical record number (MRN). Include the sending and receiving facility names, along with the contact name and phone number.
4. Indicate the transfer date and confirm whether the patient is currently under isolation precautions by checking 'Yes' or 'No'. If 'Yes', specify the type of precautions required.
5. List any organisms that the patient has or has had, including MRSA, VRE, or other multidrug-resistant organisms, and ensure to include any documentation that may support this information.
6. In the Symptoms section, identify any current symptoms by checking the appropriate boxes. If no symptoms are present, indicate that PPE is not required.
7. In the Personal Protective Equipment Considerations section, evaluate if PPE is necessary based on the answers provided in the earlier sections, and check accordingly.
8. Fill out the contact information of the person completing the form, including their role and the date.
9. Review all filled sections to ensure accuracy and completeness. Finally, save your changes, and download or print the form for submission.

Submit your INFECTION CONTROL TRANSFER FORM online to facilitate a smooth and safe patient transition.