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Cdph interfacility transfer form

CDPH Interfacility Infection Control Transfer Form 2025

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The CDPH Interfacility Infection Control Transfer Form is a document designed to accompany patients during transfers between healthcare facilities. It ensures the receiving facility is informed about the patient's infection status, including any multidrug-resistant organisms (MDROs) or other significant infections. The form collects essential patient information, current symptoms, isolation status, medical devices in use, and vaccination history to facilitate effective infection control and continuity of care.

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Click ‘Get Form’ to open the CDPH Interfacility Infection Control Transfer Form in the editor.
Begin by filling in the 'Sending Facility Name' and 'Address' sections. Ensure that you provide accurate contact information, including telephone and fax numbers.
Enter patient details such as 'Last Name', 'First Name', and 'Date of Birth'. This information is crucial for proper identification during transfer.
Complete the section regarding multidrug-resistant organisms (MDRO). Indicate if the patient has a positive culture and attach any relevant reports.
Fill out the symptoms section by checking applicable boxes. This helps convey important health information to the receiving facility.
Indicate if the patient is currently in isolation and specify the type if applicable. This ensures appropriate precautions are taken upon arrival.
Lastly, document vaccination history, including dates administered and any known lot numbers. This provides essential immunization records for continuity of care.

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Versions	Form popularity	Fillable & printable
2013	4.3 Satisfied (31 Votes)
2013	4.8 Satisfied (175 Votes)

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What are Interfacility transfers?

Introduction. Interfacility transport is defined as the transport of patients between two healthcare facilities. The process is generally accomplished through ground transportation or air vehicles.

What is the difference between inter and intra transport?

The prefix inter indicates that it can be available in more than one location. But the prefix intra indicates that it is located within something. Nevertheless, modes of transportation for more than one thing will employ at least two modes of shipment. This is vital for transporting both people and goods.

Can you transfer from one hospital to another?

The transfer of a patient from one hospital to another, or from a hospital to a nursing home, is a medical decision that must be made by a physician. In this situation, the administrator may be able to argue that the patients best interest requires a transfer to a different facility.

What is an inter hospital transfer?

The intra- and inter-hospital patient transfer is an important aspect of patient care which is often undertaken to improve upon the existing management of the patient. It may involve transfer of patient within the same facility for any diagnostic procedure or transfer to another facility with more advanced care.

What is a patient transfer form?

The purpose of this form is to insure continuity of care in transfer from hospital to extended care facility or extended care facility to hospital.

infection control test answer key

Cdph interfacility Transfer form Interfacility transfer guidelines Intrafacility transfer Intrafacility vs interfacility KPC Transfer form Patient transfer form pdf Interfacility definition Infection control forms for long term care

What are the two types of patient transfers?

Transfers can be vertical (i.e. from a seated-to-seated position (wheelchair to toilet) or supine-to-seated position (bed to wheelchair)) and horizontal or lateral (i.e. from one flat surface to another (bed to stretcher)).