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Interagency Transfer Forms


Interagency Transfer Forms were developed for use when transferring patients/residents from one healthcare facility to another. Mandatory use of the forms began January 1, 2007. Please note that this type of communication record is already required by the Joint Commission and Medicare. In addition, the State Survey Agency reviews these forms when investigating complaints lodged by one provider against another.

Who should be using the Interagency Statewide Facility Transfer Forms?

All healthcare providers in the State of Delaware who transfer patients/residents from one healthcare facility to another are to use the Interagency Statewide Facility Transfer Forms. All patients being discharged from a hospital to a long-term care facility, transferring a resident from a long-term care facility to a hospital or hospital emergency room, or transferring a patient from one healthcare provider to another within the State of Delaware.

What are the forms?

The Interagency Transfer Forms consist of two universal user friendly forms:

These templates are designed to be printed on each facility's letterhead.

Note: you must have Adobe Reader to access these forms - if you do not have Adobe, click the link at the right of this web page.

Why should I use the forms?

The use of the Interagency Transfer Forms became mandatory for all Delaware facilities on January 1, 2007. In addition, the use of the forms will improve the quality of care by providing pertinent clinical information to providers transferring or discharging patients/residents throughout the healthcare continuum. This process is an opportunity to improve the quality of care for those we serve in the State through collaboration, increased communication, and information sharing.