Forms Book Infection Control LTCS Books Long Term Care Solutions www.LTCSBooks.com
Infection Report
DATE________________________
RESIDENT / EMPLOYEE________________________________________________
SITE OF INFECTION
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Urinary Tract |
Respiratory Tract |
GI Tract |
Skin / Soft Tissue |
Blood Borne |
Other |
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Date Signs and Symptoms Observed_____________________
Description of Signs and Symptoms_________________________________________________
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Diagnostic Test__________________________________________________________________
Date_______________________
Results_________________________________________________________________________
Organism Identified______________________________________________________________
Antibiotic Therapy Used__________________________________________________________
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