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Inter-facility Infection Control Transfer Form (adapted from CDC by Clark County, WA) Please attach copies of the latest culture reports with susceptibilities if available Patient/Resident Last Name

How to fill out inter-facility infection control transfer

How to fill out inter-facility infection control transfer:

1. Start by completing the header section of the transfer form, including the name of the sender facility, recipient facility, date of transfer, and patient information.
2. Next, provide a detailed description of the infection control measures and precautions that were in place at the sender facility. This may include information about isolation protocols, hand hygiene practices, and any specific procedures followed to prevent infections.
3. Include a summary of the patient's current infection status, including the type of infection, any laboratory test results, and the date of onset.
4. Provide information about any medical interventions or treatments that have been carried out to manage the infection. This could include details about antibiotics administered, surgical procedures performed, or any other relevant interventions.
5. Document any specific instructions or precautions that the recipient facility should follow upon receiving the patient. This may include information about isolation requirements, equipment sterilization procedures, or any other necessary precautions to prevent the transmission of the infection.
6. Finally, ensure that the transfer form is signed and dated by the responsible healthcare professional.

Who needs inter-facility infection control transfer:

1. Inter-facility infection control transfer is typically needed when a patient with an active infection is being transferred from one healthcare facility to another.
2. This could include transfers between hospitals, long-term care facilities, rehabilitation centers, or any other healthcare institution where infection control is a priority.
3. The purpose of this transfer is to ensure that the receiving facility is aware of the patient's infection status, the precautions that were in place at the sending facility, and any necessary measures to prevent the spread of the infection. This allows for continuity of care and helps to minimize the risk of healthcare-associated infections.

For pdfFiller’s FAQs

What is inter-facility infection control transfer?

Inter-facility infection control transfer is the process of transferring an infected patient from one medical facility to another while taking necessary precautions to prevent the spread of infection.

Who is required to file inter-facility infection control transfer?

Medical facilities and healthcare providers are required to file inter-facility infection control transfer when transferring infected patients.

How to fill out inter-facility infection control transfer?

Inter-facility infection control transfer forms can typically be filled out online or through the healthcare facility's internal system.

What is the purpose of inter-facility infection control transfer?

The purpose of inter-facility infection control transfer is to ensure proper infection control measures are taken when transferring infected patients to different healthcare facilities.

What information must be reported on inter-facility infection control transfer?

Information such as the patient's medical history, current infection status, transfer destination, and any necessary precautions to prevent the spread of infection must be reported on inter-facility infection control transfer forms.

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