Nursing Home Resident Transfer Agreement
Nursing Home Resident Transfer Agreement
This Nursing Home Resident Transfer Agreement ("Agreement") is entered into on [date], by and between [Your Company Name], hereinafter referred to as the "Sending Facility," located at [Your Company Address], and [Receiving Facility Name], hereinafter referred to as the "Receiving Facility," located at [Receiving Facility Address].
Whereas, the Sending Facility currently provides care and accommodation to the resident identified herein, and it has been determined that a transfer to the Receiving Facility is necessary and in the best interest of the resident;
Now, therefore, in consideration of the mutual promises and covenants contained herein, the parties agree as follows:
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Resident Information: The resident who is the subject of this transfer is:
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Name: [Resident's Name]
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Date of Birth: [Date of Birth]
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Medical Record Number: [MRN]
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Any known allergies or medical conditions: [Allergies or Medical Conditions]
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Reason for Transfer: The reason for the transfer is [Briefly describe the reason for the transfer, such as medical necessity, preference of the resident, or facility capacity issues].
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Responsibilities of the Sending Facility:
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The Sending Facility agrees to provide complete and accurate medical records and documentation pertaining to the resident's care and treatment.
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The Sending Facility shall coordinate with the Receiving Facility to ensure a smooth transition for the resident.
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The Sending Facility shall ensure that all necessary arrangements for transportation and transfer of the resident are made in a timely manner.
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Responsibilities of the Receiving Facility:
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The Receiving Facility agrees to accept the resident into the facility and provide appropriate care and accommodations.
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The Receiving Facility shall review and acknowledge receipt of the resident's medical records and documentation provided by the Sending Facility.
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The Receiving Facility shall ensure that all necessary arrangements for the resident's admission and care are in place upon arrival.
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Financial Arrangements: Any financial arrangements related to the transfer shall be agreed upon separately between the Sending Facility and the Receiving Facility and/or the resident or their legal representative.
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Legal Representatives or Guardians: If applicable, the legal representatives or guardians of the resident shall be involved in the decision-making process regarding the transfer and shall ensure that the resident's interests are protected throughout the transfer process.
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Effective Date and Term: This Agreement shall become effective as of the date first written above and shall continue until the completion of the transfer process and the resident's admission to the Receiving Facility.
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Governing Law: This Agreement shall be governed by and construed in accordance with the laws of [State/Country].
IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the date first above written.
Sending Facility:
[Sending Facility Authorized Signatory]
[Date]
Receiving Facility:
[Receiving Facility Authorized Signatory]
[Date]
