CA TB Suspect Request for Hospital Discharge/Transfer Approval Form - Ventura County 2018-2025 free printable template
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TB Suspect Request for Hospital Discharge/
Transfer Approval Form
Tel: 8053859451 Fax: 8053859445
Weekend and after hours: 8052147057Patient Name:
DOB:
Address:
Phone:
Alternate phone:Submitting Facility:
Submitted
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How to fill out CA TB Suspect Request for Hospital DischargeTransfer
How to fill out CA TB Suspect Request for Hospital Discharge/Transfer Approval
01
Obtain the CA TB Suspect Request form from the relevant health department or hospital.
02
Fill out the patient's identification information, including name, date of birth, and medical record number.
03
Provide details of the hospital where the patient is currently admitted.
04
Include the reason for discharge or transfer, specifying why TB suspect approval is necessary.
05
Attach any relevant medical records or reports that support the TB suspect status.
06
Sign and date the form to confirm accuracy and authenticity.
07
Submit the completed form to the appropriate TB control authority for review and approval.
Who needs CA TB Suspect Request for Hospital Discharge/Transfer Approval?
01
Healthcare providers managing patients suspected of having tuberculosis.
02
Hospitals that need to ensure proper discharge or transfer procedures for TB suspect patients.
03
Public health officials involved in monitoring and controlling TB outbreaks.
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What is CA TB Suspect Request for Hospital Discharge/Transfer Approval?
The CA TB Suspect Request for Hospital Discharge/Transfer Approval is a formal request used to assess and manage the discharge or transfer of patients suspected of having tuberculosis (TB), ensuring appropriate protocols are followed to protect public health.
Who is required to file CA TB Suspect Request for Hospital Discharge/Transfer Approval?
Healthcare providers, such as physicians or nurses, who are involved in the care of patients diagnosed or suspected of having tuberculosis are required to file this request.
How to fill out CA TB Suspect Request for Hospital Discharge/Transfer Approval?
To fill out the CA TB Suspect Request, the healthcare provider should complete the designated form, providing accurate patient information, suspected diagnosis, treatment details, and justification for discharge or transfer, along with signatures as required.
What is the purpose of CA TB Suspect Request for Hospital Discharge/Transfer Approval?
The purpose of the request is to ensure that public health protocols are upheld when discharging or transferring TB suspects, minimizing the risk of TB transmission to others within healthcare facilities and the community.
What information must be reported on CA TB Suspect Request for Hospital Discharge/Transfer Approval?
The information that must be reported includes patient identification details, clinical history, TB symptoms, test results, treatment plans, risk of transmission assessment, and the names and contact information of healthcare providers involved.
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