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1Side 1: LCF Communication to Dialysis FacilityCOVID19 Status Communication Form Between Nursing/Personal Care/Assisted Living Facility and Dialysis Facility Patient Name: Date of Birth: / / LCF Name:
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Start by gathering all the necessary information about the 1 ltcf communication.
02
Begin by filling out the personal details section, including your name, address, and contact information.
03
Move on to the purpose of the communication, clearly stating why you are contacting the ltcf.
04
Next, provide any relevant background information or history that the ltcf needs to know.
05
Be concise and specific when describing the issue or concern you are addressing.
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If applicable, include any supporting documents or evidence to strengthen your communication.
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Who needs side 1 ltcf communication?

01
Side 1 ltcf communication is typically needed by individuals who wish to communicate with a long-term care facility (ltcf). This could include family members or legal guardians of ltcf residents, healthcare professionals, or anyone involved in the care or management of ltcf residents. It is important to fill out side 1 ltcf communication accurately and completely to ensure effective communication with the ltcf.
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Side 1 ltcf communication refers to the communication document submitted by long-term care facilities to report COVID-19 vaccination information for residents and staff.
Long-term care facilities are required to file side 1 ltcf communication.
Side 1 ltcf communication can be filled out electronically on the CDC's National Healthcare Safety Network (NHSN) portal.
The purpose of side 1 ltcf communication is to track and report COVID-19 vaccination data for residents and staff in long-term care facilities.
Information such as the number of residents and staff vaccinated, vaccine manufacturer, lot numbers, and vaccination dates must be reported on side 1 ltcf communication.
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