Medical Transfer Note

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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:

• Chronic Obstructive Pulmonary Disease (COPD)

• Hypertension

• Recent history of pneumonia

Current Medications:

• Albuterol 90 mcg inhaler (as needed)

• Lisinopril 20 mg daily

• Prednisone 10 mg daily

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.

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Transferring Physician:

• Name: Dr. [Your Name]

• Date: October 8, 2094

Contact Information:

• Phone Number: [Your Company Number]

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