Medical Transfer Note
Patient Information:
Patient Name: Cyrus Ortiz
Date of Birth: January 1, 2050
Medical Record Number: 123456
Gender: Male
Transfer Information:
Transfer Date: October 8, 2094
Time of Transfer: 10:00 AM
Transferring Facility/Unit: St. Mary's Hospital, Emergency Department
Receiving Facility/Unit: Mercy General Hospital, Intensive Care Unit
Reason for Transfer:
Patient requires specialized care for severe respiratory distress not manageable at the transferring facility.
Medical History:
Current Medications:
Vital Signs at Transfer:
Blood Pressure: 150/90 mmHg
Heart Rate: 110 bpm
Respiratory Rate: 24 breaths/min
Temperature: 98.6°F
Oxygen Saturation: 85% on room air
Summary of Current Condition:
Patient is alert but in moderate respiratory distress. Auscultation reveals wheezing and diminished breath sounds bilaterally. The patient has been receiving oxygen therapy with a nasal cannula, which has not improved saturation levels.
Transfer Instructions:
Monitor vital signs every 15 minutes during transport.
Administer supplemental oxygen as needed to maintain SpO2 above 90%.
Prepare for potential intubation upon arrival at the receiving facility.
Transferring Physician:
Name: Dr. [Your Name]
Date: October 8, 2094
Contact Information:
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