Get the free Long-Term-Care Facility Transfer Form - LeadingAge Oregon - leadingageoregon

LongTermCare Facility Transfer Form (for use in accordance with OAR 3330190052 when transferring a resident infected or colonized with a multidrug resistant organism, MDR) TRANSFERRING FACILITY: RECEIVING

How to fill out long-term-care facility transfer form

How to fill out a long-term-care facility transfer form:

1. Start by gathering all the necessary information. This may include the patient's personal details, medical history, and current medication list. Ensure you have all the relevant documentation before beginning the form.
2. Begin filling out the form by accurately documenting the patient's personal information. This typically includes their full name, date of birth, address, and contact details. Double-check the information to avoid any errors.
3. Proceed to the next section, which usually requires specifying the reason for the transfer. Clearly state whether it is for medical reasons, rehabilitation, or any other relevant purpose. Be concise in your explanation.
4. Provide additional information regarding the patient's medical history. This may include any significant diagnoses, recent surgeries, allergies, and current medical conditions. Ensure you include all relevant and important details to help the receiving facility provide appropriate care.
5. If the patient is currently on any medication, accurately list the name, dosage, and frequency of each medication. This information is crucial for the new facility to ensure continuity of care and prevent any potential drug interactions.
6. Some long-term-care facility transfer forms require information about the patient's primary healthcare provider or referring physician. Provide their name, contact details, and any other necessary information to ensure effective communication.
7. The form may include a section for the patient's family or next of kin details. Include their names, relationships to the patient, and contact information for emergency purposes.
8. Finally, carefully review the completed form to ensure accuracy and completeness. Make sure all mandatory fields are filled out and any necessary signatures are obtained. Consider making copies of the form for your records.

Who needs a long-term-care facility transfer form?

1. Individuals who require care beyond what can be provided at their current location, such as nursing homes or assisted living facilities, may need a long-term-care facility transfer form.
2. Patients who are transitioning from a hospital or rehabilitation center to a long-term-care facility often need this form to facilitate a smooth transfer of care.
3. Individuals who are being transferred between long-term-care facilities due to a change in their medical, physical, or mental condition may also require a transfer form.
4. This form is typically necessary for healthcare providers, social workers, and case managers involved in coordinating and managing the patient's care.

For pdfFiller’s FAQs

What is long-term-care facility transfer form?

The long-term-care facility transfer form is a document used to transfer a patient/resident from one long-term care facility to another.

Who is required to file long-term-care facility transfer form?

The healthcare provider or facility is required to file the long-term-care facility transfer form.

How to fill out long-term-care facility transfer form?

To fill out the long-term-care facility transfer form, you must provide details about the patient/resident, reason for transfer, current facility information, and receiving facility information.

What is the purpose of long-term-care facility transfer form?

The purpose of the long-term-care facility transfer form is to ensure a smooth and proper transfer of a patient/resident from one facility to another while maintaining continuity of care.

What information must be reported on long-term-care facility transfer form?

The long-term-care facility transfer form must include patient/resident details, reason for transfer, current facility information, receiving facility information, and any special care instructions.

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