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Policy for the Discharge and transfer of children and young people ...

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Appendix 8-TRANSFER DOCUMENTSample only. Forms available from paediatric HDUPLEASE AFFIXPATIENT'S ADDRESSOGRAPHPatient's Weight ………………………………………………Date: …………………………………………Time: …………………………………….1. Discussion with receiving unit / Name <strong>of</strong> Staff Member…………………………..………2. H<strong>and</strong>over provided…………………….……..…………………………………………….Mode <strong>of</strong> Transport: 3. Departure time Ambulance Hospital Transport……………….…….……………………………………………………….Para-Medic AmbulanceOwn TransportO<strong>the</strong>r ……………………………………………………………Destination: ………………………………………………………………………………….…Receiving Doctor: ………………………………… Tel. No: ………………………………...Receiving Nurse: ………………………………….. Tel. No: ………………………………...Accompanying Staff / Family:Dr: ……………………………………………………..Nurse: ……………………………………………….…Parent / Carer / O<strong>the</strong>r: …………………………………Contact Details <strong>of</strong> Parent / Carer / O<strong>the</strong>r: …………………………………………………….Current Care Issues:1. ………………………………………………………………2. ………………………………………………………………3. ………………………………………………………………Principle reason <strong>for</strong> <strong>transfer</strong>:<strong>Policy</strong> <strong>for</strong> <strong>the</strong> discharge <strong>and</strong> <strong>transfer</strong> <strong>of</strong> <strong>children</strong> <strong>and</strong> <strong>young</strong> <strong>people</strong> from child healthPage 29 <strong>of</strong> 38

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