Get High Peaks Hospice Patient Transfer Form 2012-2025

Completing the High Peaks Hospice Patient Transfer Form online is essential for ensuring a smooth and effective transfer of care. This guide will provide you with a comprehensive overview of each section and field in the form, helping you fill it out accurately and efficiently.

Follow the steps to complete the form accurately.

1. Click 'Get Form' button to access the Patient Transfer Form and open it in your editor.
2. Begin by entering the date of the form at the top. This should reflect the current date on which you are filling out the form.
3. Input the patient's name and medical record number. Ensure that this information is accurate to avoid any confusion.
4. Fill in the name of the facility to which the patient is being transferred, along with the address, state, and zip code.
5. Specify the date of transfer and the time the physician was notified, indicating whether it was in the AM or PM.
6. List the attending physician at the time of transfer and the date when they last saw the patient.
7. Under the qualifying and other prior stay information section, provide the reason for transfer and include the primary and secondary diagnosis of the patient.
8. Detail any other conditions that may be relevant and note any allergies that the patient has.
9. Include physician orders on the transfer and any nursing evaluations required. For the face-to-face assessment, indicate yes or no.
10. Complete the nursing evaluation section by assessing the patient's speech, hearing, sight, mental status, feeding, dressing, elimination, bathing, and ambulatory status. Mark the appropriate options based on the patient's condition.
11. In the physical activity section, document any notable points about the patient's current activity levels.
12. Add any nursing assessments and recommendations that may be necessary for the patient's future care.
13. Ensure the nurse's signature, title, and date are included in the designated area.
14. Document the current medications along with the date and time of the last dose provided.
15. Capture the patient's attitude toward the transfer and attach any summary material regarding social or emotional factors if needed.
16. Outline the course of care and services provided in the past, attaching additional sheets if necessary.
17. Record your name in the recorded by section and date the form accordingly.
18. Finally, review all the entered information for accuracy before saving the changes. You can then download, print, or share the completed form.

Fill out your High Peaks Hospice Patient Transfer Form online today to ensure a seamless transfer of care.