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Illinois EMS for ChildrenPediatric Interfacility Transfer Agreement
Contact Resource Information
June 2016
Hospital Numeration
LocationContact PersonContact Info
7086842065 (office)
7086844865 (fax)
Michelle.
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How to fill out pediatric interfacility transfer agreement
How to fill out pediatric interfacility transfer agreement
01
Gather all necessary information such as patient's name, age, and contact information.
02
Make sure to have a copy of the pediatric interfacility transfer agreement form.
03
Fill out the form carefully, providing accurate and complete information.
04
Indicate the reason for the transfer and the specific medical condition of the patient.
05
Include details about the sending and receiving facilities, including names, addresses, and contact information.
06
Specify the mode of transportation for the transfer, whether it's by ambulance, helicopter, or other means.
07
Provide any additional relevant information, such as special medical equipment or personnel required during the transfer.
08
Ensure all necessary signatures are obtained, including those of the parent or legal guardian.
09
Review the completed form for any errors or missing information before submission.
10
Submit the filled-out pediatric interfacility transfer agreement to the appropriate authorities or departments.
Who needs pediatric interfacility transfer agreement?
01
Pediatric hospitals and medical facilities that engage in interfacility patient transfers.
02
Medical professionals involved in the transfer of pediatric patients between healthcare institutions.
03
Parents or legal guardians of pediatric patients who require transfer from one medical facility to another.
04
Regulatory bodies or agencies responsible for overseeing healthcare transfers and ensuring compliance.
05
Emergency medical service providers and personnel involved in pediatric patient transport.
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What is pediatric interfacility transfer agreement?
Pediatric interfacility transfer agreement is a formal agreement between healthcare facilities to transfer pediatric patients between them.
Who is required to file pediatric interfacility transfer agreement?
Healthcare facilities that provide pediatric care and anticipate transferring pediatric patients.
How to fill out pediatric interfacility transfer agreement?
The agreement should be filled out with all relevant patient information and signed by authorized representatives of both facilities.
What is the purpose of pediatric interfacility transfer agreement?
The purpose is to ensure a smooth and safe transfer of pediatric patients between healthcare facilities.
What information must be reported on pediatric interfacility transfer agreement?
Patient demographics, medical history, reason for transfer, and any special needs or considerations.
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