Q&A: Patient Transfer Information

Q: What information should case managers provide to patients when they are transferring from a hospital to another healthcare facility?

A: Patients transferred to a facility are sent with the following information for the receiving facility:

• Instructions regarding care to be given, written information about symptoms that require seeking immediate medical attention, and how to get help
• Whom to contact when symptoms continue
• Medication reconciliation; information about medications, dosage, risks, and side effects
• Written instructions about follow-up care, pending diagnostic tests, appointments to make, and phone numbers for postacute providers or services
• Instructions/discharge summary by 48 hours to the postacute care practitioner
• Test results to the postacute practitioner within 24 hours of availability
• Medical Orders for Life-Sustaining Treatment and physician certification statement to skilled home health agency
• A list of available postacute care providers given to the patient if still needed

For more information, see the Case Management Patient Communication Toolkit.

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