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CDPH Interfacility Infection Control Transfer Form 2026
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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' fields, ensuring accurate contact information for seamless communication.
- Enter the patient's details, including 'Last Name', 'First Name', 'Date of Birth', and 'Medical Record Number'. This information is crucial for proper identification.
- Complete the sections regarding multidrug-resistant organisms (MDRO) by checking applicable boxes and providing any necessary culture reports.
- Indicate if the patient has any symptoms listed, such as productive cough or fever, and specify if they are currently in isolation.
- Fill out the device section if applicable, noting any medical devices currently in use along with their insertion dates.
- Lastly, document vaccination history by entering details about administered vaccines, including dates and brands where known.
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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.
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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)).
Related links
Use this form for all transfers to an admitting healthcare facility. Patient Name (Last, First):. Date of Birth: MRN: Transfer Date: Receiving Facility Name (Read more
Feb 1, 2021 Developed a modified infection control transfer form to help members communicate when admitting hospital transfers. This form can be usedRead more