Get the free Infection Control Transfer Form Example 2 PDF - 240 KB - cdc

INTERACTIVITY INFECTION CONTROL TRANSFER FORM FOR STATES ESTABLISHING HAI PREVENTION COLLABORATIVESThis example Interfacility Infection Control patient transfer form can assist in fostering communication

How to fill out infection control transfer form

How to fill out an infection control transfer form:

1. Begin by gathering all essential information. This includes the patient's full name, date of birth, and contact information. Additionally, you will need to know the healthcare facility the patient is transferring from and the one they are transferring to.
2. Ensure that the form includes a section for documenting the reason for transfer. This is important for maintaining accurate records and ensuring continuity of care.
3. Include a section in the form where the transferring facility can provide a summary of the patient's medical history and current condition. This may include details about their diagnosis, any ongoing treatments or medications, and any infection control protocols that need to be followed during the transfer.
4. It's crucial to have a section in the form where the receiving facility can acknowledge their acceptance of the patient and confirm their ability to provide the necessary infection control measures. This helps ensure a smooth and safe transfer process.
5. Consider including a section where healthcare professionals can document any specific infection control precautions that need to be taken during the transfer. For example, if the patient is on isolation precautions due to a contagious disease, this information should be clearly indicated.

Who needs an infection control transfer form:

1. Hospitals and healthcare facilities that tend to have a high number of patient transfers, such as tertiary care centers.
2. Long-term care facilities, including nursing homes, that may need to transfer patients to hospitals or specialized facilities for specific treatments or procedures.
3. Ambulance services and emergency medical technicians (EMTs) who may need to transport patients from one facility to another.

Overall, the infection control transfer form is essential for maintaining accurate records, ensuring patient safety, and providing continuity of care during the transfer process.

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What is infection control transfer form?

The infection control transfer form is a document used to record and transfer information about a patient's infectious disease status when transferring to another healthcare facility.

Who is required to file infection control transfer form?

Healthcare providers such as hospitals, clinics, and long-term care facilities are required to file the infection control transfer form.

How to fill out infection control transfer form?

The form typically requires information about the patient's infectious disease status, infection control measures, and contact information of the sending and receiving facilities.

What is the purpose of infection control transfer form?

The purpose of the infection control transfer form is to ensure that necessary precautions are taken to prevent the spread of infectious diseases when a patient is transferred between healthcare facilities.

What information must be reported on infection control transfer form?

Information such as the patient's infectious disease status, isolation precautions, and potential exposure risks should be reported on the infection control transfer form.

What is the penalty for late filing of infection control transfer form?

The penalty for the late filing of the infection control transfer form may include fines, sanctions, or other regulatory actions imposed by the relevant authorities.