Patient Transfer 3-Part Form - CLOSEOUT ITEM

Briggs Patient Transfer forms provide information necessary for proper patient care when transferring to another facility. Includes information on advance directives and vitals. 

Both forms printed two sides different. The back contains information regarding the patient’s ability to perform ADLs and his/her psychosocial disposition. After completing the front side, pull out feather-edge carbon, turn form over, reinsert carbon face down, and complete second side.

Updates include (but not limited to) additions of:

·       Infectious/Communicable Disease to Diagnoses at Time of Transfer

·       Vitals at Time of Transfer now include Weight, O2 Saturation, Respirations and regular vs. irregular AP

·       Risk factors: fall, wandering, choking and smoker

·       Herpes Zoster vaccination and date

·       Body diagram and Skin Status with legend/key to prompt clinician to identify issues with skin status; also added an option to designate another attached document for wound care orders

·       New questions in Social Information: patient involved in discharge planning and whether or not the transferring facility's bed hold policy was given to/sent with resident (required by 2016 Final Rule (RoPs)

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