Get Jdd Vamc Patient Transfer Request Form. Jdd Vamc Patient Transfer Request Form

Filling out the JDD VAMC Patient Transfer Request Form is essential for facilitating patient transfers within the healthcare system. This guide will provide you with step-by-step instructions to ensure you complete the form accurately and efficiently.

Follow the steps to complete the JDD VAMC Patient Transfer Request Form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the today's date and time at the top of the form. Ensure you use the correct date format as specified.
3. Enter the patient's name. Make sure to provide the full name as it appears on their official documents.
4. Provide the patient's full Social Security Number (SSN) to ensure proper identification.
5. Input the patient's date of birth (DOB) in the specified format.
6. Complete the CMOR section, which may refer to case management or other relevant information.
7. Circle the appropriate option indicating the patient's status: NSC (non-service connected) or SC (service connected). If SC, be sure to attach the HINQ report.
8. Request any necessary paperwork to be faxed to the admitting facility, such as lab work, progress notes, history and physical documentation, and vital signs.
9. Indicate whether the patient is eligible for travel by selecting YES or NO, and provide the eligibility justification if necessary.
10. Fill in the name and complete address of the hospital where the patient is being transferred.
11. Specify the location of the patient within the hospital, such as ER, ICU, or ward.
12. Enter the name and contact number of the treating physician responsible for the patient's care.
13. Record the admission date and diagnosis of the patient accurately.
14. The requesting facility's physician must answer the questions provided regarding the patient's condition and indicate whether the patient requires a higher level of care.
15. Complete the Bed Service Requested section by indicating the type of bed needed (ICU, medicine, surgery, psych) and the specific location.
16. List the contact person's name(s), title, telephone number, and fax number for follow-up communications.
17. Include any additional comments, especially regarding the last known status of this request and last VA visit details.
18. The form should also include the coordinator or authorized official's name as it pertains to the JDD VAMC.
19. Once you have completed the form, save your changes. You may also download, print, or share the form as needed.

Complete the JDD VAMC Patient Transfer Request Form online today to facilitate a smooth patient transfer.