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1. Parties: Identification of the transferring and receiving healthcare facilities, including their legal names, addresses, and licensing information
2. Background: Context of the agreement, including the purpose of establishing a formal transfer relationship and the general scope of services
3. Definitions: Key terms used throughout the agreement, including clinical, operational, and administrative terminology
4. Scope of Services: Detailed description of the types of transfers covered, patient populations, and medical conditions included in the agreement
5. Transfer Criteria and Protocols: Specific medical and operational criteria for patient transfers, including stability requirements and contraindications
6. Responsibilities of Parties: Detailed obligations of both transferring and receiving facilities before, during, and after transfer
7. Communication Requirements: Protocols for communication between facilities, including point of contact information and documentation requirements
8. Medical Record Requirements: Standards for medical documentation transfer, including timing and format of records
9. Quality Assurance: Procedures for monitoring transfer quality, reviewing outcomes, and addressing issues
10. Insurance and Liability: Requirements for insurance coverage and allocation of liability between parties
11. Term and Termination: Duration of the agreement, renewal provisions, and circumstances for termination
12. General Provisions: Standard legal clauses including governing law, dispute resolution, and amendment procedures
1. Financial Arrangements: Details of payment terms and billing procedures if transfers involve financial compensation between facilities
2. Special Equipment Requirements: Specific requirements for specialized medical equipment during transfers, used when transfers routinely involve complex medical needs
3. Training and Education: Requirements for staff training and continuing education related to transfers, important for facilities with specific clinical expertise
4. Research and Data Sharing: Protocols for sharing data and conducting research, relevant when facilities have academic or research partnerships
5. Disaster Planning: Special provisions for mass casualty events or disasters, important in high-risk areas or between major medical centers
6. Specialized Service Lines: Specific protocols for particular service lines (e.g., pediatrics, trauma, cardiac), used when transfers focus on specific patient populations
1. Schedule A - Transfer Protocol Checklist: Detailed step-by-step checklist for patient transfer procedures
2. Schedule B - Communication Protocol: Contact information, communication chain of command, and emergency contact procedures
3. Schedule C - Required Documentation Forms: Standard forms required for patient transfers, including consent forms and transfer records
4. Schedule D - Clinical Criteria Matrix: Detailed medical criteria for different types of transfers and patient conditions
5. Schedule E - Quality Metrics: Specific quality indicators and benchmarks for monitoring transfer effectiveness
6. Appendix 1 - Facility Capabilities: Detailed list of each facility's capabilities, equipment, and specialties
7. Appendix 2 - Staff Qualifications: Required qualifications for staff involved in patient transfers
8. Appendix 3 - Emergency Response Procedures: Specific procedures for emergency situations during transfers
Healthcare
Emergency Services
Medical Transport
Public Health
Healthcare Administration
Medical Services
Government - Healthcare
Legal
Risk Management
Clinical Operations
Emergency Services
Quality Assurance
Compliance
Patient Care
Medical Affairs
Administration
Emergency Medicine
Hospital Administrator
Medical Director
Chief Medical Officer
Risk Management Officer
Legal Counsel
Chief Nursing Officer
Emergency Department Director
Quality Assurance Manager
Compliance Officer
Transfer Coordinator
Clinical Operations Manager
Healthcare Facility Director
Patient Care Director
Emergency Services Manager
Medical Transport Director
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