Get the free NON-EMERGENCY PATIENT TRANSFER FORM - southeasthealthline

Southeastern Patient Transfer Services Inc. 556 O 'Connor Drive Kingston, ON K7P 1N3 DISPATCH PHONE 18554614440 EMERGENCY PATIENT TRANSFER FORM Fax 18556310228 DATE REQUESTED APPOINTMENT TIME & DATE

How to fill out non-emergency patient transfer form

How to Fill Out Non-Emergency Patient Transfer Form:

1. Obtain the form: The first step is to acquire a non-emergency patient transfer form. You can obtain this form from the hospital or healthcare facility where the transfer is taking place. It may also be available online on the facility's website.
2. Fill in patient information: Begin by entering the patient's personal information accurately. This includes the patient's full name, date of birth, address, phone number, and any other relevant contact details.
3. Provide medical history: Next, fill in the patient's medical history. This should include any pre-existing conditions, allergies, current medications, or specific medical requirements that the receiving facility should be aware of.
4. Indicate reason for transfer: Specify the reason for the patient transfer. It could be for specialized treatment, medical evaluation, or a change in the level of care required. Clearly state the purpose of the transfer to ensure accurate and appropriate arrangements are made at the receiving facility.
5. Include contact information: Provide the contact information of the referring physician, healthcare provider, or hospital representative who is coordinating the transfer. This allows the receiving facility to communicate and collaborate effectively throughout the transfer process.
6. Outline desired arrangements: Specify any specific arrangements or instructions required for the transfer. This may include transportation preferences, accommodation needs, or any additional medical equipment or services that may be necessary during the transfer.
7. Obtain necessary signatures: Ensure that all required signatures are obtained on the form. This may include the patient's signature or the signature of their legal guardian if applicable. Additionally, the transferring healthcare provider or representative may need to sign the form to validate the transfer request.

Who Needs Non-Emergency Patient Transfer Form:

1. Patients requiring specialized treatment: Non-emergency patient transfer forms are necessary for individuals who need to be transferred to a healthcare facility that can provide specialized care not available at the current facility.
2. Patients requiring medical evaluation: Sometimes, a physician may request a non-emergency transfer to a different facility in order to receive a comprehensive medical evaluation or consultation from a specialist.
3. Patients requiring a change in the level of care: Non-emergency patient transfers may be required when a change in the level of care is necessary. For example, a patient may need to be moved from a general ward to an intensive care unit (ICU) or vice versa, based on their medical condition.

In conclusion, filling out a non-emergency patient transfer form involves providing accurate patient information, detailing medical history, indicating the reason for transfer, including contact information, outlining arrangements, and obtaining necessary signatures. These forms are needed for patients requiring specialized treatment, medical evaluation, or a change in the level of care.

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What is non-emergency patient transfer form?

Non-emergency patient transfer form is a document used to request the transfer of patients who do not require immediate medical attention.

Who is required to file non-emergency patient transfer form?

Healthcare facilities or medical transportation providers are required to file non-emergency patient transfer forms.

How to fill out non-emergency patient transfer form?

Non-emergency patient transfer forms can be filled out by providing patient information, reason for transfer, and transportation details.

What is the purpose of non-emergency patient transfer form?

The purpose of non-emergency patient transfer form is to ensure a safe and efficient transfer of patients between healthcare facilities.

What information must be reported on non-emergency patient transfer form?

Information such as patient's name, medical history, reason for transfer, receiving facility, and transportation arrangements must be reported on non-emergency patient transfer form.