Acute Communicable Disease Standard of Practice Evaluation Form: Individual
Circle appropriate period
Documentation reflects consideration of client’s needs in determining interventions and/or on-going revisions of the plan of care (p. C5).
Documents client understands the disease process and prevention of transmission (p. C5).
Initiates action for non-adherent client/contacts (p. C6).
Follows up with non-adherent client/contacts (p. C6).
Completes forms or report and submits investigation forms within 5 days of closure or timeframe agreed upon in consultation with PHNS (p. C6).
Follows up on referrals as reported by client if more than one contact is needed (p. C5).
© 2007 LAC DPH-Public Health Nursing