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DELAWARE INTERAGENCY PATIENT TRANSFER FORM EMERGENT Patient Name Date of BirthTransferring FacilityContact Numberless 4 Digits of Engender PreferenceMPrimary NurseFContact NumberReason & Time for
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How to fill out delaware interagency patient transfer
How to fill out delaware interagency patient transfer
01
To fill out Delaware interagency patient transfer form, follow these steps:
02
Begin by providing the patient's personal information, including their full name, date of birth, and social security number.
03
Next, provide the patient's contact information, such as their address, phone number, and email address.
04
Indicate the transferring facility's information, including the name, address, and contact details.
05
Specify the date and time of the transfer.
06
Describe the reason for the transfer and include any necessary medical information or diagnosis.
07
Mention if the patient requires any special accommodations or equipment during the transfer.
08
Provide details of any accompanying healthcare professionals or family members.
09
Finally, ensure all required signatures are obtained and date the form at the bottom.
10
Make sure to review the completed form for accuracy and submit it to the appropriate authorities or healthcare facility.
Who needs delaware interagency patient transfer?
01
Delaware interagency patient transfer form is needed in situations where a patient requires transportation or transfer from one healthcare facility to another within the state of Delaware. This form ensures proper coordination and communication between different agencies involved in the transfer process, such as hospitals, long-term care facilities, and emergency medical services (EMS). It is primarily used for interagency transfers to ensure the safe and efficient movement of patients while maintaining continuity of care.
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