HAN Public Alerts

Publication Date 
Alert ID 
Topic 
Title 
2021-02-26 2:43 PM46665227Influenza
2021-02-24 6:25 PM46665217COVID19
2021-02-23 6:06 PM46665344COVID19
2021-02-23 2:15 PM46665343COVID19
2021-02-23 9:17 AM46665342COVID19
2021-02-20 1:48 PM46665339COVID19
2021-02-19 2:43 PM46665213Influenza
2021-02-18 10:09 AM46665331COVID19
2021-02-17 7:27 PM46665330Opioid Concerns
2021-02-17 9:44 AM46665199COVID19
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inter-facility infection prevention 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