Get the free Interfacility Transfer Form.docx - doh sd
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SouthDakotaInterfacilityInfectionControlTransferForm
PleaseusethisformwhentransferringapatientwithCarbapenemresistant
Enterobacteriaceae(CRE)
Thisformmustbefilledoutfortransfertoacceptingfacilitywithinformationcommunicatedpriortoorwithtransfer.
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How to fill out interfacility transfer formdocx:
01
Start by opening the interfacility transfer formdocx on your computer.
02
Fill in the patient's personal information, including their name, date of birth, and contact details.
03
Provide the details of the transferring facility, including its name, address, and contact information.
04
Enter the details of the receiving facility, including its name, address, and contact information.
05
Fill in the reason for the transfer and any additional notes or comments related to the transfer.
06
Indicate the mode of transportation that will be used for the transfer, whether it is by ambulance, helicopter, or other means.
07
Obtain the necessary signatures from the transferring facility, receiving facility, and the patient or their legal representative.
08
Review the completed form for accuracy and make any necessary corrections.
09
Save the filled-out form and make copies for your records and any other parties involved, if necessary.
Who needs interfacility transfer formdocx:
01
Medical professionals and healthcare providers involved in the transfer of a patient from one facility to another.
02
Hospitals, clinics, and healthcare facilities that are transferring patients to another location for further care or specialized treatment.
03
Patients or their legal representatives who are involved in the decision-making process for the transfer and need to provide consent or important information.
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What is interfacility transfer formdocx?
The interfacility transfer formdocx is a document used to transfer patients between healthcare facilities.
Who is required to file interfacility transfer formdocx?
Healthcare providers and facilities are required to file the interfacility transfer formdocx when transferring patients.
How to fill out interfacility transfer formdocx?
To fill out the interfacility transfer formdocx, healthcare providers must include necessary patient information, reason for transfer, and other relevant details.
What is the purpose of interfacility transfer formdocx?
The purpose of the interfacility transfer formdocx is to ensure smooth and proper transfer of patients between healthcare facilities.
What information must be reported on interfacility transfer formdocx?
The interfacility transfer formdocx must include patient's name, medical history, reason for transfer, receiving facility information, and any special instructions.
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