Get the free MATERNAL TRANSFER RECORD - College of Medicine University - medicine usask

Addressograph or Label MATERNAL TRANSFER RECORD Last Name First Name Mother's Address DOB D M Y Postal Code HAN Next of Kin: Relationship: CPI# Phone: (H) Phone (Cell) Bed Line called: DD MM BY hrs.

How to fill out maternal transfer record

How to fill out a maternal transfer record:

1. Obtain the necessary forms: Begin by acquiring the maternal transfer record form from the appropriate healthcare facility or provider. This form is typically used to document the transfer of a pregnant individual to a different healthcare provider or hospital.
2. Patient information: Enter the patient's personal information, including their full name, date of birth, contact information, and any relevant identification numbers. This ensures proper identification and facilitates communication between healthcare providers.
3. Current healthcare provider/hospital details: Fill in the details of the healthcare provider or hospital from where the patient is being transferred. Include their name, address, contact information, and any other relevant identifiers. This enables seamless communication and continuity of care.
4. Reason for transfer: Clearly indicate the reason for the transfer of the patient. Whether it is due to medical necessity, personal preference, or any other specific circumstance, provide a concise explanation for the transfer.
5. Date and time of transfer: Record the date and time when the transfer is happening or has occurred. This is crucial for accurately tracking the patient's medical journey and ensuring a smooth transition of care.
6. Receiving healthcare provider/hospital details: Enter the details of the healthcare provider or hospital where the patient will be transferred. Include their name, address, contact information, and any relevant identifiers. This information is essential for the receiving healthcare provider to prepare for the patient's arrival and continue their care seamlessly.
7. Patient's medical history: Document the key medical history of the patient, including any pre-existing conditions, allergies, medications, and ongoing treatments. This information assists the receiving healthcare provider in understanding the patient's medical background and tailoring their care accordingly.
8. Medications and treatment plan: Provide a comprehensive list of the patient's current medications, dosages, and frequencies. Additionally, include any ongoing treatment plans or protocols that the patient is currently undergoing. This information helps the receiving healthcare provider ensure continuity of the patient's medical management.
9. Signatures and contact information: Affix the necessary signatures on the maternal transfer record, including those of the patient, the current healthcare provider, and the receiving healthcare provider. Additionally, enter the contact information for both the transferring and receiving parties, including names, phone numbers, and email addresses. This facilitates communication and collaboration between the healthcare providers involved.

Who needs a maternal transfer record?

A maternal transfer record is typically required in situations where a pregnant individual needs to be transferred to a different healthcare provider or hospital. This can happen due to various reasons such as medical complications, specialized care requirements, personal preference, or logistic considerations.

The maternal transfer record ensures proper communication and continuity of care between the transferring and receiving healthcare providers. It allows the healthcare professionals involved to have a comprehensive understanding of the patient's medical history, ongoing treatments, and specific needs, thus enabling them to provide appropriate care during the transfer process and beyond.

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What is maternal transfer record?

Maternal transfer record is a document that records the transfer of a pregnant woman from one healthcare facility to another.

Who is required to file maternal transfer record?

Healthcare facilities and healthcare providers are required to file maternal transfer records.

How to fill out maternal transfer record?

Maternal transfer records should be filled out with the pregnant woman's medical information, reason for transfer, and details of the receiving facility.

What is the purpose of maternal transfer record?

The purpose of maternal transfer record is to ensure continuity of care for pregnant women who are transferred between healthcare facilities.

What information must be reported on maternal transfer record?

The maternal transfer record must include the pregnant woman's medical history, current condition, reason for transfer, and contact information.