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Interagency Transfer Forms


Delaware Interagency Transfer Forms

 
Background:

Interagency Transfer Forms were developed for use when transferring patients/residents from one healthcare facility to another. The purpose of the form is to optimize safe, effective and efficient communication between healthcare providers and settings. Please note that this type of communication record is required by Delaware law and  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:

 

 (1) DELAWARE INTERAGENCY TRANSFER FORM – EMERGENT
 

The Delaware Interagency Transfer Form (for Emergent transfers) was updated in 2019 to reflect input from a wide variety of healthcare facilities, providers and the state. All Delaware healthcare facilities/providers are required to use this form when transferring a resident/patient into the acute care (hospital) setting for emergent care. 
 
Click HERE to access the DELAWARE INTERAGENCY TRANSFER FORM – EMERGENT 
 

(2) DELAWARE INTERAGENCY NURSING COMMUNICATION RECORD- NON EMERGENT

 
The state will be working over upcoming months to update the current DELAWARE INTERAGENCY NURSING COMMUNICATION RECORD – NON EMERGENT version and once complete, it will be released for use by Delaware facilities transferring NON EMERGENT clients/patients from one healthcare setting, to another non-emergent healthcare settings/providers. 
 
Click HERE to access the DELAWARE INTERAGENCY NURSING COMMUNICATION RECORD - NON EMERGENT

 

Why Should I Use The Forms?

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.
 
Questions/Comments, please contact the Delaware Division of Healthcare Quality with at 302-292-3930 or DHSS_DHCQ_OHFLCFax@delaware.gov  

 
 

Coronavirus Disease (COVID-19)

For up to date information on Coronavirus Disease (COVID-19), please visit de.gov/coronavirus. If you have questions, please contact the Delaware Division of Public Health call center at 1-866-408-1899 or email dphcall@delaware.gov