TRANSFER FORM

Transfer interim order form allows you to complete a transfer order and send to physicians letting them know that the patient has been transferred to a facility during their Encounter (not discharged). This form can provide the physician with the following information:

• Patient demographics
• ID #
• Referral Source
• Primary Diagnosis
• Disciplines Providing Service
• Start of Care Date
• Current Orders
• Medications
• Lab Data
• Patient’s Transfer Condition
• Patient Outcomes & Comments
• Patient/Family Post-Transfer Instructions
• Reasons for Home Health
• Facility Transfer to

To create the interim order, click on the drop down to the right of the 485 and choose "Add Interim Order".  Then choose "Transfer Form". Enter the effective date and click "Save". 

Example of Transfer Form