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STOCKHOLDERS AGREEMENT, Dated as of December 21, This Form

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STOCKHOLDERS AGREEMENT, Dated as of December 21, This Form

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hi I'm going to guide you through the HS 602 transfer agreement this form is used to facilitate the continuity of care and the timely transfer of patients and records between the admitting general acute care hospital that agrees to accept the transfer and the facility this form is a two-page form that requires information from the hospital and the facility please list the complete name of the general acute care hospital which I'll refer to as hospital on the first line of the agreement below the name of the hospital complete street address of the hospital the third line is for the city state and zip code of the hospital below the capitalized word and enter facility information this is for the facility requesting licensure name of the facility this transfer agreement is valid for the complete street address of the facility on the next line and the third line is for the city state and zip code of the facility items number one through eleven are the terms of the agreement

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