Get the free 5102 Interfacility Transfers - Department of Health Services

COUNTY OF SACRAMENTO EMERGENCY MEDICAL SERVICES AGENCYDocument #5102.13PROGRAM DOCUMENT:Initial Date:12/28/93Last Approval Date:03/14/19Effective Date:05/01/19Next Review Date:03/01/20Interfacility

How to fill out 5102 interfacility transfers

How to fill out 5102 interfacility transfers

1. Step 1: Obtain a copy of the 5102 interfacility transfers form.
2. Step 2: Fill out the patient's personal information, including their name, date of birth, and contact information.
3. Step 3: Specify the details of the transferring facility, such as its name, address, and contact information.
4. Step 4: Provide information about the receiving facility, including its name, address, and contact information.
5. Step 5: Indicate the reason for the transfer and any relevant medical condition or treatment the patient requires.
6. Step 6: Sign the form and include the date.
7. Step 7: Send the completed form to the appropriate authorities or parties involved in the transfer.

Who needs 5102 interfacility transfers?

1. 5102 interfacility transfers are needed by healthcare facilities, such as hospitals, clinics, or specialized care centers, when transferring a patient from one facility to another.
2. This form helps ensure a smooth transition for the patient and provides necessary information for the receiving facility to provide appropriate care.
3. It is also required for legal and administrative purposes to document the transfer of patients between healthcare facilities.

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What is 5102 interfacility transfers?

5102 interfacility transfers refer to the transfer of patients between healthcare facilities for further care or treatment.

Who is required to file 5102 interfacility transfers?

Healthcare facilities, such as hospitals and clinics, are required to file 5102 interfacility transfers when transferring patients.

How to fill out 5102 interfacility transfers?

To fill out 5102 interfacility transfers, healthcare facilities must provide detailed information about the patient being transferred, the sending and receiving facilities, as well as the reason for the transfer.

What is the purpose of 5102 interfacility transfers?

The purpose of 5102 interfacility transfers is to ensure the safe and timely transfer of patients between healthcare facilities while maintaining continuity of care.

What information must be reported on 5102 interfacility transfers?

Information that must be reported on 5102 interfacility transfers includes patient demographics, medical history, reason for transfer, sending and receiving facility details, and transportation arrangements.