Consent Form Hiv Test Page 8
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42Operating Procedure 153-31
June 14, 2010
Report Form DH 2139 and Addendum (DH 2134), if needed, within five (5) working days of
diagnosis.
(3)
Periodic Reporting to Hospital Infection Control:
(a)
the
occurrence
of
any
disease
indicating
underlying
cellular
immunodeficiency that occurs following the completion of Florida Adult HIV/AIDS Confidential
Case Report Form DH 2139 and DH 2134 (if needed);
(b)
any change in resident’s residence;
1.
transfer from one ward to another;
2.
transfer from one unit to another;
3.
release from hospital;
4.
escape or elopement from hospital.
(c)
the Unit Daily Infection Control Report may be used for this reporting using
appropriate coding (Florida State Hospital Operating Procedure 153-16, Surveillance Program
for Reporting of Endemic Levels of Common Illnesses and Communicable Diseases).
(4)
External Reporting Requirements:
(a)
The Department of Health Laboratory Request for HIV Testing, Form 1628
(Attachment 11), when completed contains risk factors for HIV as well as other demographic
information. The Department of Health will collect needed data from the Form 1628 which
accompanies specimens sent to the Department of Health Bureau of Laboratory Services for
processing.
(b)
HIV positive residents and residents who are diagnosed as AIDS cases will
be reported to the Gadsden County Health Department and/or the Department of Health Bureau
of HIV/AIDS on Form DH 2139 and DH 2134 (if needed) by Hospital Infection Control within
designated time frames in accordance with the confidential reporting procedures for
communicable diseases required by Florida state law and regulations.
h.
Monitoring and Reporting Requirements:
(1)
Florida State Hospital has three (3) communicable disease monitoring groups:
Civil Services, Forensic Services, and Staff Personnel. These monitoring groups, which shall
include a Senior Physician, will be headed by the respective Assistant Hospital Administrators,
with Hospital Legal Counsel, Hospital Clinical Director, Risk Manager, and Hospital Infection
Control Nurses acting as consultants. One of the functions of these monitoring groups is to
assist in making decisions regarding treatment and placement of residents with HIV/AIDS.
(2)
Florida State Hospital Staff Development will be responsible for monitoring and
reporting staff education. All staff training completed will be documented on a Staff Training and
Information Reporting System (STAIRS) Form and, if the training was done by Unit Staff,
furnished to Staff Development by the end of each month. Staff development will maintain a
record of employees and dates of attendance at HIV/AIDS Educational Classes.
The
Department Of Health shall have authority to review the records of each facility to determine
compliance.
8
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