Canada NLIHT-001 2020-2025 free printable template

Intercostal Transfer Form SECTION I: CONTENTS:Shipment Invoice #: Shipping Ambient Temp:To (Hospital/RNA): 40C or greater less than 40CFrom (Hospital/RNA):Blood Components: Unit Number/RhModifiersVisual

How to fill out inter-hospital transfer form

How to fill out inter-hospital transfer form

1. Step 1: Start by downloading the inter-hospital transfer form from the hospital's website or request a physical copy from the admitting department.
2. Step 2: Fill out the patient's personal information, including their full name, date of birth, gender, and contact information.
3. Step 3: Provide the details of the referring hospital, including their name, address, and contact information.
4. Step 4: Include the details of the receiving hospital, including their name, address, and contact information.
5. Step 5: Specify the reason for transfer and any relevant medical conditions or concerns.
6. Step 6: Indicate the mode of transportation for the transfer, such as ambulance or air transport.
7. Step 7: Include the details of the healthcare provider responsible for the transfer, including their name, contact information, and professional title.
8. Step 8: If applicable, attach any supporting documents, such as medical reports, lab results, or imaging scans.
9. Step 9: Review the form for accuracy and completeness before submitting it to the hospital's admitting department.
10. Step 10: Submit the filled-out inter-hospital transfer form to the admitting department and keep a copy for your records.

Who needs inter-hospital transfer form?

1. Inter-hospital transfer forms are needed by patients or their healthcare providers when they require transferring a patient from one hospital to another.
2. These forms help ensure a coordinated and seamless transfer of care while providing necessary medical information to the receiving hospital.
3. Both the referring hospital and the receiving hospital need the inter-hospital transfer form to communicate important details regarding the patient's condition, medical history, and transportation arrangements.

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What is inter-hospital transfer form?

The inter-hospital transfer form is a document used to transfer a patient from one hospital to another.

Who is required to file inter-hospital transfer form?

The transferring hospital is required to file the inter-hospital transfer form.

How to fill out inter-hospital transfer form?

The inter-hospital transfer form must be filled out with patient information, reason for transfer, receiving hospital details, and any relevant medical information.

What is the purpose of inter-hospital transfer form?

The purpose of the inter-hospital transfer form is to ensure a smooth and safe transfer of a patient from one hospital to another.

What information must be reported on inter-hospital transfer form?

The inter-hospital transfer form must report patient details, reason for transfer, current treatment being given, receiving hospital information, and any special instructions.