Get Mrsa Surveillance Form For Ltcf

Filling out the MRSA Surveillance Form for Long-Term Care Facilities (LTCF) accurately is crucial for effective infection control. This guide provides clear, step-by-step instructions on how to complete the form online to ensure comprehensive data collection.

Follow the steps to complete the form online.

1. Click ‘Get Form’ button to access the MRSA Surveillance Form for LTCF and open it in your preferred document editor.
2. Provide the facility name where the resident is located. Ensure that this is the official name for accurate documentation.
3. Enter the telephone number for the facility to facilitate any necessary follow-up communication regarding the form.
4. Fill in the resident's name in the format of 'Last Name, First Name' to maintain standardization.
5. Indicate the resident's sex by selecting the appropriate option available.
6. Enter the resident's date of birth in the format (M/D/Y) or provide their age, as applicable.
7. Record any recent hospitalizations, including the dates and the room number or wing of the resident during each admission.
8. Specify the room type where the resident is accommodated within the facility.
9. Input the date the resident was first admitted to the facility to track their duration of care.
10. Log the admit date and the discharge date to keep a clear record of the resident's stay.
11. Document the date of the first MRSA positive culture to assist in tracking infection onset.
12. Describe the site of colonization or infection and its onset date, ensuring accuracy in detailing the medical condition.
13. Indicate whether the patient has been cleared of MRSA by selecting 'Yes' or 'No'. This should reflect the latest testing outcome.
14. After ensuring all fields are filled accurately, you can save changes, download, print, or share the form as needed.

Complete your MRSA Surveillance Form for LTCF online to support better health outcomes.