HAN Public Alerts

Publication Date 
Alert ID 
2020-06-04 12:14 PM46663091COVID19
2020-06-03 5:10 PM46662986COVID19
2020-06-02 4:00 PM46663089VFC
2020-05-29 10:12 AM46663083COVID19
2020-05-28 10:54 AM46662978Announcement
2020-05-22 2:14 PM46662607Influenza
2020-05-21 5:22 PM46662699COVID19
2020-05-20 5:53 PM46662601COVID19
2020-05-15 2:09 PM46662598Influenza
2020-05-13 2:49 PM46662684COVID19
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

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