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PHYSICIAN SCREENING FORM CHG HEALTHCARE If you have received the health tests listed below from a health care provider on or after April 1, 2020, you may have the provider complete the bottom part
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How to fill out infection prevention and control

01
Wear appropriate personal protective equipment such as gloves, masks, and gowns.
02
Practice proper hand hygiene by washing hands with soap and water or using alcohol-based hand sanitizer.
03
Follow standard precautions when handling potentially infectious materials.
04
Implement proper environmental cleaning and disinfection protocols.
05
Educate staff on proper infection prevention and control practices.

Who needs infection prevention and control?

01
Healthcare workers including doctors, nurses, and other medical professionals.
02
Patients in healthcare facilities.
03
Individuals working in high-risk occupations such as food handling or sanitation.
04
Individuals with weakened immune systems.
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Infection prevention and control involves practices and procedures to prevent the spread of infections within healthcare settings.
Healthcare facilities and providers are required to implement infection prevention and control measures.
Infection prevention and control plans are typically filled out by healthcare administrators or infection control specialists.
The purpose of infection prevention and control is to protect patients, staff, and visitors from acquiring and spreading infections.
Information on hand hygiene, isolation precautions, cleaning and disinfection protocols, and surveillance of healthcare-associated infections must be reported.
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