PATIENT TRANSFER FORM - Health Care Improvement Foundation 2026

1. Click ‘Get Form’ to open the PATIENT TRANSFER FORM in the editor.
2. Begin by filling in the patient’s last name, first name, and middle initial. Ensure accuracy as this information is crucial for identification.
3. Indicate the decision maker by selecting either 'Self' or 'Durable POA (Health Care Proxy)' and provide their name and relationship to the patient.
4. Complete the Advance Directives section by checking 'Yes' or 'No' and attaching any relevant documents if applicable.
5. Fill in vital signs at the time of transfer, including height, weight, blood pressure, temperature, pulse, respiration rate, and pulse oximetry.
6. Document any known allergies and medications. If there are none, check the appropriate boxes.
7. Provide details about the transferring facility including its name and contact information. Note any at-risk alerts that may apply.
8. In the reason for transfer section, include a brief medical history to ensure continuity of care.
9. Complete isolation/precaution details if necessary and document any diagnoses related to mental health.
10. Finally, review all sections for completeness before signing off on the form. Ensure all attached documents are included as indicated.

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