CA CDPH Interfacility Infection Control Transfer Form 2013 free printable template
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CDP Interfacility Infection Control Transfer Form Disclaimer: This form should be sent with the patient upon transfer. Please fax to Infection Control department of receiving facility. It is NOT meant
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How to fill out CA CDPH Interfacility Infection Control Transfer
How to fill out CA CDPH Interfacility Infection Control Transfer Form
01
Obtain the CA CDPH Interfacility Infection Control Transfer Form from the California Department of Public Health website or your facility's infection control office.
02
Fill in the facility name, address, and contact information at the top of the form.
03
Provide patient information, including name, medical record number, date of birth, and any relevant medical history.
04
Indicate the reason for transfer in the designated section on the form.
05
Document any current infections or potential exposure risks the patient may have.
06
Fill in the necessary details regarding the receiving facility, including its name and contact information.
07
Ensure all relevant sections are signed and dated by the transferring authorized personnel.
08
Review the completed form for accuracy before sending it with the patient.
Who needs CA CDPH Interfacility Infection Control Transfer Form?
01
The CA CDPH Interfacility Infection Control Transfer Form is needed by healthcare providers transferring patients between facilities, particularly when the patient has an infection or is at risk of infection.
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What is CA CDPH Interfacility Infection Control Transfer Form?
The CA CDPH Interfacility Infection Control Transfer Form is a standardized document used to communicate important infection control information when patients are transferred between healthcare facilities.
Who is required to file CA CDPH Interfacility Infection Control Transfer Form?
Healthcare facilities, including hospitals and other patient care organizations, are required to file the CA CDPH Interfacility Infection Control Transfer Form when transferring patients who may pose an infection risk.
How to fill out CA CDPH Interfacility Infection Control Transfer Form?
To fill out the CA CDPH Interfacility Infection Control Transfer Form, follow the provided instructions by entering patient information, pertinent medical history, and specific infection control concerns before transferring the form to the receiving facility.
What is the purpose of CA CDPH Interfacility Infection Control Transfer Form?
The purpose of the CA CDPH Interfacility Infection Control Transfer Form is to ensure the safe transfer of patients and to provide necessary infection control information to prevent the spread of infections during interfacility transfers.
What information must be reported on CA CDPH Interfacility Infection Control Transfer Form?
The information that must be reported on the CA CDPH Interfacility Infection Control Transfer Form includes the patient's identification details, relevant medical history, infection status, any precautions or care instructions, and details about the transferring facility.
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