HAN Public Alerts

Publication Date 
Alert ID 
2021-04-20 4:42 PM46665809COVID19
2021-04-19 3:04 PM46665807COVID19
2021-04-19 12:25 PM46665916Announcement
2021-04-16 3:05 PM46665806Influenza
2021-04-14 8:40 PM46665801COVID19
2021-04-13 6:53 PM46665797STI
2021-04-13 4:17 PM46665800COVID19
2021-04-13 2:53 PM46665799COVID19
2021-04-13 9:29 AM46665796COVID19
2021-04-09 3:17 PM46665794Influenza
false null [0, 1, 2, 3]

Inter-facility Infection Control Transfer Form

An inter-facility infection prevention transfer form has been developed as part of a regional effort to improve communication between acute and long-term healthcare facilities. The purpose of the form is to convey information about a patient’s isolation precautions and the reason for their implementation to the receiving facility. The sending facility should record current infection and colonization information. The form is not intended to be a comprehensive documentation of microbiologic history and does not replace review of medical records and communication between care providers. 

Please fill out this form and send it with all patients being transferred between facilities, regardless of whether or not they require isolation.

Please click here for the form.

Questions or feedback about the form may be addressed by the CDPH HAI Unit: cdphhaiar@cityofchicago.org