Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by entering the patient information, including the medical record number, the unit, and the resident's name. Ensure that names are spelled correctly for accurate documentation.
3. Fill in the date of the most recent admission to the nursing facility and the date and time of the unplanned transfer. Use military time for accuracy.
4. Describe the reason for the unplanned transfer clearly, providing detailed information about the circumstances surrounding the transfer.
5. Next, address the '72 Hours Prior to Transfer' section. Indicate whether any signs, symptoms, or conditions were present prior to the transfer, such as fever, change in mental status, or decreased oral intake.
6. Detail the actions taken prior to the transfer by answering the questions regarding contact with a physician or nurse practitioner, evaluations that occurred, and whether the transfer was due to a lack of services.
7. Describe any medications, lab tests, or diagnostic tests relevant to the transfer in the provided fields.
8. Summarize the outcome, documenting any pertinent details about the patient's condition and care following the transfer.
9. Indicate whether the transfer could have been avoided and provide an explanation if applicable.
10. Complete the action plan section by suggesting actions that might improve identifying and managing changes in resident health status.
11. Finally, include the reviewer's name and title and complete the date field. Once all sections are filled out, save your changes, and you may download, print, or share the form as needed.

Take the next step in enhancing patient care by completing the Skilled Nursing Facility Chart Review Form online today.