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CDPH Interfacility Infection Control Transfer Form 2026

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The CDPH Interfacility Infection Control Transfer Form is a document designed to accompany patients during transfers between healthcare facilities. It includes essential information regarding the patient's infection status, medical history, and current treatments to ensure continuity of care. The form must be sent with the patient and faxed to the receiving facility's Infection Control department, but it is not intended as admission criteria.

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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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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

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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)).

CDPH Interfacility Infection Control Transfer Form 2026

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How to use or fill out CDPH Interfacility Infection Control Transfer Form with our platform

See more CDPH Interfacility Infection Control Transfer Form versions

Complete this form in 5 minutes or less

Got questions?

What are Interfacility transfers?

What is the difference between inter and intra transport?

Can you transfer from one hospital to another?

What is an inter hospital transfer?

What is a patient transfer form?

Security and compliance

Complete this form in 5 minutes or less

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What are the two types of patient transfers?

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