Login
Try for Free
Home
ED Transfers
ED Transfers
Copy Link
Created by Qualaris Staff
Emergency Department
Critical Access Hospital
Table of Contents
Audit Form
Audit Form
ED Transfers
Description
Demonstrate compliance with EMTALA Transfer law.
Required
Observed Date
ED Transfers Checklist
Mark all as...
Was the patient entered into the central log?
Yes
No
Was the emergency medical screening exam completed?
Yes
No
Was the correct disposition of patient chosen according to policy?
Yes
No
Was the patient stable prior to transfer and documented as such?
Yes
No
If the Pt was unstable, was there documentation of risks vs benefits?
Yes
No
N/A
If the Pt refused stablizing treatment or appropriate transfer mode, was there documentation of refusal?
Yes
No
N/A
If the Pt refused treatment, was there an AMA form completed?
Yes
No
N/A
Was there documentation of the receiving facility name and acceptance of Pt?
Yes
No
Was there documentation of the receiving physician?
Yes
No
N/A
Was there documentation that the medical record was sent?
Yes
No
Was there a transfer order present?
Yes
No
Did the physician document the mode of transfer?
Yes
No
Did the physician document the disposition and condition?
Yes
No
Was there documentation of the nurse to nurse report?
Yes
No
Were the vital signs taken immediately prior to transfer and documented?
Yes
No
