Patient Transfer 2-Part Form

UPDATED 2023

Briggs Patient Transfer form provides information necessary for proper patient care when transferring to another facility. Includes information on advance directives and vitals. Sending and receiving facilities keep one copy of this 2-part form.

After completing the front side, pull out feather-edge carbon, turn the form over, reinsert the carbon face down, and complete the second side.

The back of the form contains information regarding the patient’s ability to perform ADLs and his/her psychosocial disposition.

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