Client | Information Needed before Requesting a Transfer

Applies To: | CLIENTS


Issue: | Required Information for Requesting a Transfer.


Cause: | Not Applicable


Solution: | Information Requirements


  1. - Pickup Facility Name or Clinic/Residential Address
    - Destination Facility Name or Clinic/Residential Address
    - Transfer Pickup Date
    - Transfer Pickup Time
    - Is this a Treat and Return transfer based on an Appointment Time?
    - Appointment time if Treat and Return
    - Appointment duration if Treat and Return (hours)
    - Type of Transfer (Wheelchair,Gurney,Ambulatory)
    - Oxygen required (Y or N)
    - DNR Order (Y or N)
    - Escort attending (Y or N) and Type (RN,PSW,Non-Medical)
    - Isolation required (Y or N) and Type (RN,PSW,Non-Medical)
    - Patient ID (NO NAMES...facility Identifying Number Only)
    - Patient Weight (Kilograms Only)
    - Patient Gender
    - PTAC MT Number
    - Alternate Contact Name (optional)
    - Alternate Contact Email (optional)
    - Any additional Relevant information
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