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Transfer Log
Transfer Log
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Created by Qualaris Staff
Critical Access Hospital
Case Management
Table of Contents
Audit Form
Audit Form
Transfer Log
Required
Observed Date
Transferring Hospital
Hospital A
Hospital B
Specialty
Other
Reason for transfer
Cardiac Cath
Specialty Consult
Procedure
Higher acuity of care
Accepting Physician Type
Cardiologist
Hospitalist
Other
Transfer Log Checklist
Mark all as...
Consent has been signed?
Yes
No
Transfer paperwork completed?
Yes
No
Transfer order?
Yes
No
Report called to receiving facility?
Yes
No
