Patient Transfer Handoff Form
Use this form to document the handoff of a patient transfer between care teams or facilities. Do not enter sensitive personal, financial, or government-issued information.
Patient Identifier or Reference (non-sensitive)
*
Sending Location/Department
*
Receiving Location/Department
*
Transfer Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Reason for Transfer
*
Current Status/Condition Summary
*
Medications or Treatments in Progress
Special Handling or Transport Needs
Receiving Staff Contact Name and Phone/Extension
*
Handoff Notes or Instructions
Submit Transfer Handoff
Should be Empty: