| (vi) any other pertinent information.
(9) A facility shall comply with the following memorandum
of transfer requirements.
(A) The facility's policy shall require that a memorandum
of transfer be completed for every patient who is transferred.
(B) The memorandum shall contain the:
(i) patient's full name, if known;
(ii) patient's race, religion, national origin, age,
sex, physical handicap, if known;
(iii) patient's address and next of kin, address, and
phone number, if known;
(iv) names, telephone numbers, and addresses of the
transferring and receiving physicians;
(v) names, addresses, and telephone numbers of the
transferring facility and receiving hospital;
(vi) time and date on which the patient first presented
or was presented to the transferring physician and transferring facility;
(vii) time and date on which the transferring physician
secured a receiving physician;
(viii) name, date, and time hospital administration
was contacted in the receiving hospital;
(ix) signature, time, and title of the transferring
facility administration who contacted the receiving hospital;
(x) certification required by paragraph (5)(B)(ii)
of this subsection, if applicable (the certification may be part of
the memorandum of transfer form or may be on a separate form attached
to the memorandum of transfer form);
(xi) time and date on which the receiving physician
assumed responsibility for the patient;
(xii) time and date on which the patient arrived at
the receiving hospital;
(xiii) signature and date of receiving hospital administration;
(xiv) type of vehicle and company used to transport
the patient;
(xv) type of equipment and personnel needed in the
transfer;
(xvi) name and city of hospital to which patient was
transported;
(xvii) diagnosis by transferring physician; and
(xviii) attachments by transferring facility.
(C) A copy of the memorandum of transfer shall be retained
by the transferring facility. The memorandum shall be filed separately
from the patient's medical record and in a manner that will facilitate
its inspection by HHSC. All memorandum of transfer forms filed separately
shall be retained for at least five years.
(c) Violations. A facility violates the Act and this
section if:
(1) the facility fails to comply with the requirements
of this section; or
(2) the governing body fails or refuses to:
(A) adopt a transfer policy that is consistent with
this section and contains each of the requirements in subsection (b)
of this section;
(B) adopt a memorandum of transfer form that meets
the minimum requirements for content contained in this section; or
(C) enforce its transfer policy and the use of the
memorandum of transfer.
|
