NURSING TRANSFER NOTES
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Patient Shifted from
...........
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Petient Shifted to
..................
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Date ................................
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Time
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No.
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PARAMETERS
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1.
Diagnosis
2.
Reason
why the patient is being shifted?
3.
Is
blood cross matched and kept ready in the Blood Bank?
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4.
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Is the patient under restraints?
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Yes
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No
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5.
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Is the patient under vulnerable category?
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Yes
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No
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6.
Is
patient is a case of HIV/HBs Ag/HCV. If yes, give detail
7.
Does patient requires Barrier / Reverse Barrier nursing?
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8.
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Is patient has pressure sore, if yes, give
details
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9.
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Is patient on any medical equipment, if
yes, give details
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10.
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Is there any Lines / Tubes / Drains /
Catheters present, if any give details
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11.
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Current diet of the patient
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12.
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Special instruments
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13.
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Are all investigations
including scans and
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Yes
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No
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reports being handed over to the next
staff.
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Detail type of investigations.
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1.
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2.
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14.
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Pending Reports
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Patient handover given by : Patient handover Received by :
Name of Staff : .................................. Name of Staff : ..................................
Employee ID : .................................. Employee ID : ..................................