Get Infection Control Form

Filling out the Infection Control Form online is an important step in ensuring the safe transfer of patients or residents and the effective control of infections. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the Infection Control Form online.

1. Click ‘Get Form’ button to obtain the Infection Control Form and open it in your preferred editor.
2. Begin by entering the sending facility's name in the 'Sending From' section to identify the location transferring the patient or resident.
3. In the 'Person Completing Form' field, clearly print your name to indicate who is responsible for completing the form.
4. For 'Patient/Resident Information', print the last name, first name, and date of birth clearly or use a patient stamp where applicable.
5. Answer the question regarding whether the patient or resident is currently in isolation by selecting 'Yes' or 'No'.
6. In the 'Type' section, check all applicable boxes to indicate the type of infection control precautions needed: Contact, Droplet, Airborne, or Other.
7. Indicate if the patient currently has an infection, colonization, or a history of positive culture of a multidrug-resistant organism by selecting the appropriate options provided.
8. Complete the section regarding the patient's current condition by checking any symptoms they are experiencing, such as cough, diarrhea, or wounds needing dressing changes.
9. Specify any medical devices the patient currently has in place, such as a central line or urinary catheter, by checking the relevant boxes and filling in insertion dates as necessary.
10. Indicate if the patient is currently on antibiotics by selecting 'Yes' or 'No' and refer to the medication sheet if applicable.
11. In the vaccine section, provide the date administered for vaccines like influenza and pneumococcal, noting if the patient self-reports receiving a vaccine.
12. Upon completion of the form, ensure to save your changes. You can download, print, or share the form as needed.

Complete your Infection Control Form online today for a seamless transfer process.