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Get and Sign Form Inter Facility Transfer
Being transferred (patient request, no beds, etc.)
4. Make photocopies of all Emergency Department records and send with the patient to receiving facility.
5. Sign transfer form after all above are completed; attach copy of records going with patient to receiving facility.
Retain original with hospital records.
TO BE COMPLETED FOR EVERY TRANSFER REQUEST TO AND FROM A VA MEDICAL FACILITY
SECTION I - DEMOGRAPHIC AND ELIGIBILITY INFORMATION
4. ADDRESS
1. VETERAN'S LAST NAME- FIRST NAME- MIDDLE...
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