Infection control form 2025

1. Click ‘Get Form’ to open the infection control transfer form in the editor.
2. Begin by entering the sending facility name and the name of the person completing the form in the designated fields.
3. In the 'Patient/Resident Information' section, print clearly or use a patient stamp to fill in the last name, first name, and date of birth.
4. Indicate if the patient is currently in isolation by checking the appropriate boxes for Contact, Droplet, Airborne, or Other.
5. Answer whether the patient has an active infection or history of multidrug-resistant organisms (MDRO) by selecting 'YES' or 'NO' and providing additional details if applicable.
6. Complete questions regarding current symptoms and medical devices by checking all relevant boxes.
7. Finally, document any vaccines administered along with their dates and whether self-reporting was confirmed.

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