X hits on this document

439 views

0 shares

0 downloads

0 comments

138 / 193

Acute Communicable Disease Standard of Practice Evaluation Form: Outbreak in a Healthcare Facility

PHN

__________________________

Circle appropriate period

Oct-March

STANDARD ELEMENTS

RECORD #

RECORD #

(1)

(2)

ASSESSMENT

  • 1.

    Documentation reflects that referral was reviewed

    • (p.

      C7) as indicated by:

      • Date/Time/Signature on referral when received from PHNS.

  • 2.

    Analyzes the report per PHN Practice Manual

    • (p.

      C7) as demonstrated by the completeness or incompleteness of the data.

      • Indicates that all data was complete or follows up on missing data, if needed.

COMMENTS:

MET

NOT MET

N/A

MET

NOT MET

N/A

© 2007 LAC DPH-Public Health Nursing

April- Sept

Year

COMMENTS

F 17

Document info
Document views439
Page views439
Page last viewedTue Dec 06 19:51:56 UTC 2016
Pages193
Paragraphs8231
Words44235

Comments