Get 57.114 Urinary Tract Infection (uti) Form. 57.114 Urinary Tract Infection (uti) Form

Filling out the 57.114 Urinary Tract Infection (UTI) Form can be streamlined by following a structured approach. This guide provides clear instructions on how to complete each section of the form to ensure accurate submissions.

Follow the steps to fill out the 57.114 Urinary Tract Infection (UTI) Form online.

1. Click the ‘Get Form’ button to obtain the 57.114 Urinary Tract Infection (UTI) Form and open it in your preferred editing tool.
2. Enter the Facility ID as assigned to your healthcare facility in the designated field.
3. Fill in the required patient information: include Event #, Patient ID, and Social Security #, ensuring accurate details are provided.
4. Specify the Patient Name in the format of Last name, First name, and Middle name as applicable. Indicate the patient's Date of Birth.
5. Select the patient's Gender from the prescribed options (F, M, Other) along with Ethnicity and Race if applicable.
6. In 'Event Type', ensure 'UTI' is selected and record the Date of Event.
7. Indicate if a Post-procedure UTI occurred and provide details if applicable, including Date of Procedure and NHSN Procedure Code.
8. For MDRO Infection Surveillance, check 'Yes' or 'No' to confirm whether the infection's pathogen is in-plan.
9. Document the Date Admitted to Facility and specify the Location for the infection treatment.
10. Report on Urinary Catheter status, including its placement and provide the Date of Device Insertion if applicable.
11. Detail the Specific Event by checking either Symptomatic UTI or Asymptomatic Bacteremic UTI.
12. Specify the criteria for diagnosis by checking all relevant signs or symptoms listed under 'Specify Criteria Used'.
13. Complete the Laboratory & Diagnostic Testing section by providing evidence of infection through tests and cultures.
14. Indicate whether a Secondary Bloodstream Infection occurred and if it contributed to Dying.
15. Identify any pathogens found during testing, providing additional details on the specified pages.
16. Finally, review all entries for accuracy and save your changes, download the form, print, or share it as needed.

Complete your 57.114 Urinary Tract Infection (UTI) Form online today for effective documentation.