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ARIZONA CHILDREN ASSOCIATION Transfer of Medication Attachment 5 Date: Time Child: Medication Name Quantity RX# Doctor 1. 2. 3. 4. 5. 6. Prescriptions Yes (#) No Special Instructions: SIG. Of person

How to fill out transfer of medication

How to fill out transfer of medication:

1. Obtain the necessary forms or documents for transferring medication. This may include a transfer request form or a medication log sheet.
2. Fill in the patient's personal information accurately, such as their name, date of birth, and contact details.
3. Provide details about the medication being transferred, including the name of the medication, dosage, frequency, and any special instructions or precautions.
4. Indicate the reason for the transfer, whether it is due to a change in healthcare provider, a change in location, or any other relevant reason.
5. Include the contact information of the healthcare provider or facility where the medication is being transferred to. This may include the name, address, phone number, and fax number.
6. Sign and date the transfer form, ensuring that all required fields are completed accurately.
7. Keep a copy of the transfer form for your own records, and submit the original form to the appropriate healthcare provider or facility.

Who needs transfer of medication:

1. Patients who are transitioning between healthcare providers or facilities may require a transfer of medication. This could be due to a change in primary care physicians, transferring to a new hospital or nursing home, or shifting from one pharmacy to another.
2. Individuals who are moving to a new location may also need to transfer their medication. This ensures that their healthcare needs are properly managed in the new area.
3. In some cases, medication transfers may be necessary when a patient is participating in a clinical trial or research study and needs to transfer their medication records to another research site.

Overall, the transfer of medication is important to ensure continuity of care, proper medication management, and to avoid any disruptions in the patient's treatment plan.

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