TRANSFER NOTE

Patient: [Name]
Date of birth or ID: [Identifier]
Date and time of transfer: [Date, time]
From: [Unit or hospital, service, and attending]
To: [Unit or hospital, service, and accepting physician]
Type of transfer: [ICU to ward, ward to ICU, change of service, hospital to hospital, or hospital to rehabilitation or long-term care]
Transport and escort: [Bed move with a nurse, ground ambulance, critical care transport, or air]
Author: [Name, credentials]

REASON FOR TRANSFER
Reason: [Why the patient is moving now, in one or two sentences]
Readiness or need: [For a step-down, the criteria met; for a step-up or a transfer out, the care this unit or hospital can't give]
Accepted by: [Accepting physician, how they were reached, and the time]

SUMMARY OF STAY
Admission: [Date, presenting problem, and admitting diagnosis]
Course: [Key events, procedures, and treatments in date order, in a few lines]
Condition now: [Latest vital signs with oxygen, mental status, and the trend over 24 hours]

ACTIVE PROBLEMS
Problem 1: [Problem, status today, and the plan the receiving team should carry on]
Problem 2: [Problem, status today, and plan]
Resolved problems: [Problems settled during the stay, so they aren't worked up again]
Chronic conditions: [Home medications continued, held, or changed, and when to restart]

MEDICATIONS AND ALLERGIES
Current medications: [Drug, dose, route, frequency, and the time of the last dose]
Recent changes: [Started, stopped, or changed in the last 48 hours, and why]
Antimicrobials: [Drug, day number, and planned stop date]
Infusions: [Insulin, heparin, or other drips, with the rate and protocol, or stopped and what replaced them]
Allergies: [Drug, food, latex, and contrast allergies, with the reaction]

LINES, DRAINS, AND DEVICES
Access: [Each line, its site, the date placed, and whether it is still needed]
Drains and tubes: [Urinary catheter, chest tube, feeding tube, or surgical drain, with output and plan]
Breathing support: [Oxygen device and flow, high-flow or noninvasive settings, or tracheostomy]
Other devices: [Telemetry, pacing wires, pumps, defibrillator pads, or wound vacuum]

SAFETY
Code status and goals of care: [Decision, who took part, when last confirmed, and the named decision-maker]
Isolation: [Precautions and the organism, or none]
Risks: [Falls, delirium, aspiration, pressure injury, restraints, or one-to-one observation]
VTE prophylaxis: [Agent and dose, mechanical, or why not]
Diet: [Diet ordered, swallow screen result, or NPO and why]

PENDING AND FOLLOW-UP
Pending results: [Each test, the date sent, and who will follow it up]
Consultants: [Each service involved, its latest advice, and whether it keeps following]
Tasks for the receiving team: [What needs doing, and by when]
Escalation: [What should prompt a call or a move back, and who to call]

COMMUNICATION
Family: [Name, relationship, and what they were told about the transfer]
Patient: [What the patient understands, and agreement to the transfer]
Verbal handover: [Given to name and role, at what time, with I-PASS, SBAR, or your unit's tool; questions answered]
Records sent: [Notes, imaging, medication record, and results sent with the patient or shared electronically]

Signed: [Clinician name, credentials, date and time]