Inter-Facility Infection Control Transfer Form for States ...
Carbapenem-resistant Enterobacteriaceae (CRE) Yes Yes . Pseudomonas aeruginosa, multidrug-resistant Yes Yes . Candida auris. Yes Yes Other, specify (e.g., lice, scabies, norovirus, influenza): Yes Yes . Does the person* currently have any of the following? (Check here if none apply) Cough or requires suctioning Central line/PICC (Approx. date ...
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