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:
Resident Information: The resident who is the subject of this transfer is:
Name: [Resident's Name]
Date of Birth: [Date of Birth]
Medical Record Number: [MRN]
Any known allergies or medical conditions: [Allergies or Medical Conditions]
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].
Responsibilities of the Sending Facility:
The Sending Facility agrees to provide complete and accurate medical records and documentation pertaining to the resident's care and treatment.
The Sending Facility shall coordinate with the Receiving Facility to ensure a smooth transition for the resident.
The Sending Facility shall ensure that all necessary arrangements for transportation and transfer of the resident are made in a timely manner.
Responsibilities of the Receiving Facility:
The Receiving Facility agrees to accept the resident into the facility and provide appropriate care and accommodations.
The Receiving Facility shall review and acknowledge receipt of the resident's medical records and documentation provided by the Sending Facility.
The Receiving Facility shall ensure that all necessary arrangements for the resident's admission and care are in place upon arrival.
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.
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.
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.
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]
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