GENERIC PATIENT TRANSFER AGREEMENT #2Patient Transfer Agreement • September 20th, 2019
each individually referred to herein as “facility,” or “Transferring Facility” if transferring a patient, or “Receiving Facility” if receiving a patient, pursuant to the terms and provisions of this Agreement, and collectively as “facilities.”
PATIENT TRANSFER AGREEMENTPatient Transfer Agreement • September 19th, 2023 • California
This Patient Transfer Agreement (the “Agreement”) is made and entered into by and between <TRANSFERING PROVIDER>, the transferring provider, hereinafter referred to as “TRANSFEROR”, and <RECEIVING PROVIDER>, the receiving provider, hereinafter referred to as “RECEIVER”. (In general, both individually referred to as “Party” and collectively referred to as “Parties”.)
TRAUMA PATIENT TRANSFER AGREEMENT TEMPLATEPatient Transfer Agreement • February 23rd, 2016
referred to individually as “facility”, or “transferring facility” if transferring a patient, or “receiving facility” if receiving a patient, pursuant to the terms of this agreement, and collectively as “facilities”.
PATIENT TRANSFER AGREEMENTPatient Transfer Agreement • February 4th, 2021 • New Jersey
(this “Agreement”) is effective as of December 1, 2020 (“Effective Date”) by and between The Cooper Health System (hereinafter “Cooper”) operating under the laws of the State of New Jersey and Inspira Medical Centers, Inc. (hereinafter “Hospital”).
PATIENT TRANSFER AGREEMENT BETWEEN: _________________________________________ [Transferring Institution] ____________________________________________ [Receiving Institution]Patient Transfer Agreement • September 9th, 2020 • Washington
THIS PATIENT TRANSFER AGREEMENT, hereinafter referred to as “Agreement”, made and entered into this first day of __________________[Month, Year] by and between, ________________________[Transferring Institution], hereinafter referred to as “___________” [Institution Initials] or “institution” and ___________________________ [Receiving Institution], hereinafter referred to as “____________” [Institution Initials] or “institution”.
Patient Transfer AgreementPatient Transfer Agreement • September 30th, 2014
PATIENT TRANSFER AGREEMENTPatient Transfer Agreement • September 3rd, 2014
WHEREAS, operates a tertiary level acute care pediatric hospital to provide access to patient care for the residents of its primary service area and to provide tertiary level services on a regional and national basis to individuals requiring specialized pediatric care; and
PATIENT TRANSFER AGREEMENTPatient Transfer Agreement • December 27th, 2021
Physician: Patient Account Number: Contact Name: Title: Phone Number:_ Authorization number for transfer to Jackson County Memorial Hospital:
PATIENT TRANSFER AGREEMENTPatient Transfer Agreement • January 12th, 2021 • Minnesota
This Patient Transfer Agreement (“Agreement”), effective as of January 12, 2021 (“Effective Date”), is between Fairview Health Services doing business as Fairview Southdale Hospital (“Receiving Facility”), and
