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Request INTERMACS StandardizedDeidentified Data for Research Purposes Transfer of INTERMACS Identified Data to Researchers: Policies/Standard Operating Procedures and Data Request Form Process Identified
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How to fill out form transfer of intermacs

01
Start by downloading the Transfer of Intermacs form from the official website.
02
Fill out the patient's personal information, including name, date of birth, address, and contact information.
03
Provide details about the referring center, including the name, address, and contact information.
04
Indicate the reason for the transfer and provide any relevant medical history or notes.
05
Specify the destination center where the patient will be transferred, including the name, address, and contact information.
06
Include any additional documents or reports that may be necessary for the transfer.
07
Review the completed form for accuracy and ensure all required fields are filled out.
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Submit the form according to the instructions provided, either by mail or online.

Who needs form transfer of intermacs?

01
The form transfer of Intermacs is needed by patients who require transfer from one medical center to another for their medical care.
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It may also be required by referring centers and destination centers to facilitate the transfer process and ensure continuity of care.

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Form transfer of intermacs is used to transfer a patient from one participating institution to another within the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) program.
Healthcare providers or institutions participating in the INTERMACS program are required to file form transfer of intermacs when transferring a patient.
Form transfer of intermacs can be filled out electronically or manually with all the required patient and institution information.
The purpose of form transfer of intermacs is to ensure continuity of care and accurate documentation when transferring a patient within the INTERMACS program.
Form transfer of intermacs requires information such as patient demographics, device information, reason for transfer, and sending and receiving institution details.
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