Medical City North Hills

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on interview and record review, on 03/03/2019 the hospital failed to incorporate a discharge summary with outcome of the hospitalization and disposition of care in the medical record for 1 of 1 patient (Patient #1) that was admitted on [DATE] and was discharged on [DATE].

Findings included:

Patient #1 was admitted as an inpatient in the medical surgical floor after a surgical procedure on 12/17/2019. Patient #1 was discharged on [DATE].

Emails and phone calls were exchanged on the morning of 03/04/2020. The patient's discharge summary was requested on 03/04/2020 since the discharge summary provided to the surveyor on 03/03/2020 was a Brief Discharge Note. The note included discharge instructions and contact information to schedule a follow-up appointment with the surgeon. Personnel #1 stated medical records department did not find the patient's discharge summary. Personnel #1 was asked if the hospital's policy and procedure was to complete a discharge summary within 30 days after a patient discharge. Personnel #1 replied yes. Personnel #1 was asked where the patient was discharged to. She replied home.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on interview and record review, on 03/03/2020 the hospital failed to include in the medical record a final diagnosis and/or diagnoses within 30 days following discharge, citing 1 of 1 patient (Patient #1) that was admitted on [DATE] and discharged on [DATE].

Findings included:

Patient #1 was admitted as an inpatient in the medical surgical floor after a surgical procedure on 12/17/2019. Patient #1 was discharged on [DATE]. A discharge summary was not included in Patient #1's medical record, hence a final diagnosis and/or diagnoses was not documented.

Emails and phone calls were exchanged on the morning of 03/04/2020. The patient's discharge summary was requested on 03/04/2020 since the discharge summary provided to the surveyor on 03/03/2020 was a Brief Discharge Note. The note included discharge instructions and contact information to schedule a follow-up appointment with the surgeon. Personnel #1 stated medical records department did not find the patient's discharge summary. Personnel #1 was asked if the hospital's policy and procedure was to complete a discharge summary within 30 days after a patient discharge. Personnel #1 replied yes.

Based on record review and interview, the hospital failed to ensure medical record entries of 3 of 10 patient medical records (Patient #1,#4, and #9) were reviewed completed, signed, dated and timed.

Findings include:

1.) Patient #1 had a left carotid endarterectomy on 12/11/2018. History and Physical (H&P) was dated 11/21/2018. The update for the History and Physical that was stamped on the History and Physical states; Patient assessed. History and Physical reviewed. No changes indicated, Signature/Date and Time. The History and Physical was initialed by the physician, however there was no date and time on the H&P to indicate when the update on the H&P was reviewed and declared no changes.

2) Patient #4 had a left carotid endarterectomy on 12/11/2018. The H&P was done on 12/5/2018. The H&P had a stamp on the form that stated Patient assessed. History and Physical reviewed. No changes indicated. Signature/Date/Time. The H&P was initialed by the physician but there was no date or time of the update.

3 ) Patient #9 had a right carotid endarterectomy on 1/14/2019. The H&P was done on 1/2/2019. The H&P had a stamp on the History and Physical that stated Patient assessed. History and Physical reviewed. No changes indicated. Signature/Date/Time. The physician initialed next to the stamp however he did not date or time his signature.

The charts were reviewed with Personnel #4 on 2/26/2019 at approximately 2:30 PM and he confirmed that the History and Physical updates were not completed with a time and date of the signature as the form indicated.

Based on review of documentation and interviews of facility staff, the facility failed to inform the patient of the patient's rights in advance of furnishing care as 1 of 5 inpatient medical records reviewed did not contain admission forms signed by the patient which include receipt of the Patient Bill of Rights which resulted in an incomplete record and the patient being uninformed regarding his patient rights.

The findings were:

Electronic medical records were reviewed on the afternoon of 9/18/18 with the assistance of the quality review coordinator, staff #1. The record of patient #10 did not contain signed admission forms which included receipt of the Patient Bill of Rights. The record of patient #10 contained a nurses' note dated 8/28/18 1910 which reflected in part Received patient transfer from [another hospital] per stretcher by ambulance. Pain free, hemodynamically stable, alert oriented. Placed in hospital bed, oriented to place, time and person.

The facility policy entitled Procedure for Direct Admissions #PARA.PP.PTAC.015 dated 1/14 reflected in part Policy: Registration of direct admission patients will be performed bedside after receiving medical clearance from the attending nurse or physician. The facility policy entitled Procedure for Registration Forms and Signatures #PARA.PP.PTAC.038 dated 5/15 reflected in part The Patient Access department obtains signatures on all registration forms, from the patient or legally authorized individual, prior to or during the registration process or within a reasonable time frame based on patient circumstance ...Standard forms required at time of Pre-Registration or Registration ...2. The Conditions of Admission is obtained for all other types of Registrations (Emergency, Observation, Surgery, Inpatient and Newborn) ...3. Authorization for Release of Information. 4. Patient Bill of Rights.

In an interview with the director of patient access, staff #8 on the afternoon of 9/18/18 in the conference room, staff #8 stated in the case of direct admission, Patient Access staff will go the patient's room to get admission forms signed. Staff #8 stated that no admission forms were found in the medical record. Staff #8 stated that the usual procedure would be for Patient Access staff to return at another time to the patient's room to get the forms signed if the patient was unavailable. Staff #8 stated that the Patient Access staff should have obtained the patient's signature on the admission forms.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on review of documentation and interviews with facility staff, the facility failed to inform 1 of 5 inpatients reviewed of a mechanism for timely referral of patient concerns regarding quality of care or premature discharge to the appropriate Utilization and Quality Control Quality Improvement Organization as the Important Message from Medicare form in the medical record of patient #10 was documented by staff that the patient was unable to sign, but the medical record reflected that patient #10 was alert and oriented upon admission.

The findings were:

Electronic medical records were reviewed on the afternoon of 9/18/18 with the assistance of the quality review coordinator, staff #1. The medical record of patient #10 contained an Important Message from Medicare form which reflected Pt [patient] unable to sign dated 6/28/18 2110 witnessed by patient access staff #14 and 15. The record of patient #10 contained a nurses' note dated 8/28/18 1910 which reflected in part Received patient transfer from [another hospital] per stretcher by ambulance. Pain free, hemodynamically stable, alert oriented. Placed in hospital bed, oriented to place, time and person.

In an interview with the director of patient access, staff #8 on the afternoon of 9/18/18 in the conference room, staff #8 was asked about the date 6/28/18 on the Important Message from Medicare form as patient #10 was admitted on [DATE], and staff #8 stated the staff signing the form must have recorded the date wrong. Staff #8 stated that the usual procedure would be for Patient Access staff to return at another time to the patient's room to get the forms signed if the patient was unavailable. Staff #8 was told that the medical record reflected that patient #10 was alert and oriented on admission and staff #8 stated that the patient access staff should have had patient #10 sign the Important Message from Medicare form.

The facility policy entitled Procedure for Direct Admissions #PARA.PP.PTAC.015 dated 1/14 reflected in part Policy: Registration of direct admission patients will be performed bedside after receiving medical clearance from the attending nurse or physician. The facility policy entitled Procedure for Registration Forms and Signatures #PARA.PP.PTAC.038 dated 5/15 reflected in part The Patient Access department obtains signatures on all registration forms, from the patient or legally authorized individual, prior to or during the registration process or within a reasonable time frame based on patient circumstance ...Additional forms are required in the following situations: Important Message from Medicare ...if the patient is a Medicare or Managed Medicare Inpatient, it is required that the Important Message from Medicare be issued within two days of the inpatient admission ...In addition, the patient's or patient's representative's signature is required.

Based on review of documentation and interviews with facility staff, the facility failed to determine upon admission if 1 of 5 inpatients reviewed had formulated advanced directives as the admission forms documenting the advanced directive statements were not completed by patient #10 upon admission which resulted in an incomplete record and the facility being unaware if patient #10 had an advanced directive.

The findings were:

Electronic medical records were reviewed on the afternoon of 9/18/18 with the assistance of the quality review coordinator, staff #1. The record of patient #10 did not contain signed admission forms which included completion of the advanced directives statements in the Conditions of Admission form. The record of patient #10 contained a nurses' note dated 8/28/18 1910 which reflected in part Received patient transfer from [another hospital] per stretcher by ambulance. Pain free, hemodynamically stable, alert oriented. Placed in hospital bed, oriented to place, time and person.

The facility policy entitled Procedure for Direct Admissions #PARA.PP.PTAC.015 dated 1/14 reflected in part Policy: Registration of direct admission patients will be performed bedside after receiving medical clearance from the attending nurse or physician. The facility policy entitled Procedure for Registration Forms and Signatures #PARA.PP.PTAC.038 dated 5/15 reflected in part The Patient Access department obtains signatures on all registration forms, from the patient or legally authorized individual, prior to or during the registration process or within a reasonable time frame based on patient circumstance ...The Advanced Directives statements are contained within the Parallon standard COA (Conditions of Admission) and COS (Consent for Outpatient Services) forms ...Only one of three applicable PSDA (Patient Self Determination Act) statements is initialed or marked by the patient or legally authorized/legally empowered representative.

In an interview with the director of patient access, staff #8 on the afternoon of 9/18/18 in the conference room, staff #8 stated in the case of direct admission, Patient Access staff will go the patient's room to get admission forms signed. Staff #8 stated that no admission forms were found in the medical record. Staff #8 stated that the usual procedure would be for Patient Access staff to return at another time to the patient's room to get the forms signed if the patient was unavailable. Staff #8 stated that the Patient Access staff should have obtained the patient's signature on the admission forms.

Based on review of documentation and interviews of facility staff, the facility failed to inform the patient of Privacy Practices and obtain Authorization for Release of Information as 1 of 5 inpatient medical records reviewed did not contain admission forms signed by the patient which include the Authorization for Release of Information form and the Notice of Privacy Practices form which resulted in an incomplete record and the patient being uninformed of confidentiality rights.

The findings were:

Electronic medical records were reviewed on the afternoon of 9/18/18 with the assistance of the quality review coordinator, staff #1. The record of patient #10 did not contain signed admission forms which included Authorization for Release of Information and the Notice of Privacy Practices. The record of patient #10 contained a nurses' note dated 8/28/18 1910 which reflected in part Received patient transfer from [another hospital] per stretcher by ambulance. Pain free, hemodynamically stable, alert oriented. Placed in hospital bed, oriented to place, time and person.

The facility policy entitled Procedure for Direct Admissions #PARA.PP.PTAC.015 dated 1/14 reflected in part Policy: Registration of direct admission patients will be performed bedside after receiving medical clearance from the attending nurse or physician. The facility policy entitled Procedure for Registration Forms and Signatures #PARA.PP.PTAC.038 dated 5/15 reflected in part The Patient Access department obtains signatures on all registration forms, from the patient or legally authorized individual, prior to or during the registration process or within a reasonable time frame based on patient circumstance ...Standard forms required at time of Pre-Registration or Registration ...2. The Conditions of Admission is obtained for all other types of Registrations (Emergency, Observation, Surgery, Inpatient and Newborn) ...3. Authorization for Release of Information. 4. Patient Bill of Rights ...Procedure: Responsible Party, Patient Access. Action, Notice of Privacy Practices. The patient or legally authorized/legally empowered representative or family member initials this section to acknowledge receipt of the Notice of Privacy Practices.

In an interview with the director of patient access, staff #8 on the afternoon of 9/18/18 in the conference room, staff #8 stated in the case of direct admission, Patient Access staff will go the patient's room to get admission forms signed. Staff #8 stated that no admission forms were found in the medical record. Staff #8 stated that the usual procedure would be for Patient Access staff to return at another time to the patient's room to get the forms signed if the patient was unavailable. Staff #8 stated that the Patient Access staff should have obtained the patient's signature on the admission forms.

Based on interview and record review, the hospital failed to abide by the provider's agreement that required a hospital to comply with º42 CFR 489.24, Special responsibilities of Medicare hospitals in emergency cases. The hospital was not in compliance with the EMTALA (Emergency Medical Treatment and Labor Act) requirements, citing 1 of 1 patient (Patient #1) that presented in the emergency department (ED) the morning of 11/14/16 and returned to the ED the night of the same day.

Findings included:

Cross Refer to Tags 2406, 2407, and 2409

Based on interview and record review the hospital failed to provide an appropriate medical screening to 1 of 1 patient (Patient #1) that presented in the emergency department (ED) the morning of 11/14/16 and returned to the ED the night of the same day.

Findings included:

Patient #1 presented in the ED on 11/14/16 at 11:02 AM. Personnel #11 conducted a rapid assessment at 11:07 AM and noted Patient states he has fallen twice today and that his right knee keeps going out on him.

The EMS (Emergency Medical Services) Patient Care Report dated 11/14/16 reflected Patient #1's chief complaint was right knee pain/weakness and right elbow laceration.

At 11:32 AM right knee x-rays were conducted as ordered. At 11:58 AM the result of the Radiology-Knee, 3 view RT (right)...no acute findings.

Physician #7 noted in the HPI (History of Present Illness) Chief Complaint Fall, Extremity pain...Location lower extremity left, Quality aching, Severity: onset Moderate, Severity: current Moderate ... Physician #7 did not address the problems of the right knee.

At 11:05 AM Personnel #11 noted the patient was covered with feces and urine. Personnel #11 noted the EMS concerns about Patient #1's poor living conditions and that the patient was unable to take care of himself, the wife could not take care of the patient. Patient #1 needed maximum help in moving and with ADLs (activities of daily living). Physician #7 did not address these issues. Patient #1's current circumstances was not reported to case management.

The EMS Patient Care Report dated 11/14/16 reflected Patient #1 had Diabetes. Patient #1 had a blood sugar of 414 (via finger stick). Physician #7 did not address this problem. Patient #1's blood sugar was not rechecked in the ED and there was no order for blood work.

Patient #1 initially verbalized pain level of 10 in the scale of 1 to 10 (10 being the highest level of pain) during the nursing initial assessment. Personnel #11 noted the pain could be alleviated by pain medication. Physician #7 did not address Patient #1's pain management.

Physician #7 did not identify Patient #1's current home medications. The medical record did not reflect Patient #1's home medications and/or if the patient was compliant with his medication regimen.

In an interview on 03/27/17 at 1:50 PM and 03/28/17 at 10:00 AM, Personnel #1 was informed of the above findings and confirmed the findings.

Based on interview and record review the hospital failed to provide stabilizing treatment to 1 of 1 patient (Patient #1) that presented in the emergency department (ED) the morning of 11/14/16 and returned to the ED the night of the same day.

Findings included:

Patient #1 presented in the ED on 11/14/16 at 11:02 AM. Physician #7 did not re-evaluate Patient #1. Patient #1 had unresolved issues which was noted by nursing staff. Physician #7 did not address these unresolved issues. Noted unresolved patient issues were the following:

1) Patient #1 was unable to take care of himself. His wife could not take care of him. He had problems with moving and needed maximum assistance. He needed help with the ADLs (activities of daily living).

2) Patient #1 lived in poor living conditions.

Problems #1 and #2 were not reported to case management which was available. Case management had the ability of assisting Patient #1.

3) Patient #1 had Diabetes. The EMS Patient Care Report reflected Patient #1's blood sugar was checked in the ambulance. The result was 414 which was considered high. The blood sugar was not rechecked in the ED and/or laboratory test was not ordered for Patient #1.

4) Patient #1 had a pain level of 10 during the initial nursing assessment at 11:07 AM. Upon reassessment at 12:14 PM, Patient #1 verbalized his pain level was a 7 and could be alleviated with pain medication. There was no order for Patient #1's pain management.

5) Physician #7 did not identify Patient #1's home medications. Physician #7 did not know if Patient #1 was compliant or not with his medication regimen. There was no home medication list found in Patient #1's medical record.

In an interview on 03/27/17 at 3:00 PM and 03/28/17 at 11:30 AM, Physician #7 stated the day Patient #1 presented in the ED it was very busy. He stated he missed documenting Patient #1's re-evaluation. Physician #7 stated he saw Patient #1 about 3 times. Physician #7 stated he did not order pain medications because more than likely Patient #1 did not want pain medications. Physician #7 stated he did not receive report from the nursing staff about the above patient issues.

In an interview on 03/28/17 at 2:25 PM, Personnel #13 was asked if case management services was provided in the ED. She replied that they do. Their names, phone numbers, and daily on-call list were available at the secretary's desk. She explained if they received a report, for example like Patient #1, she would have talked to the nurse and physician to find out what was going on with the patient. She would have talked to Patient #1 and would offer resources and explore all options in order to have a safe discharge.

Based on interview and record review the hospital failed to provide appropriate transfer/discharge of 1 of 1 patient (Patient #1) that presented in the emergency department (ED) the morning of 11/14/16 and was discharged at 2:00 PM. Patient #1 returned to the ED on the same day at 11:19 PM.

Findings included:

Patient #1 presented in the ED on 11/14/16 at 11:02 AM. The triage notes indicated Patient states he has fallen twice today and that his right knee keeps going out on him. The initial vital signs at 11:07 AM were as follows: BP 232/107, Pulse 102, Temp 36.5 (Celsius), Pulse Ox 96, Resp 20. At 12:12 PM Clonidine 0.2 mg tablet per oral was administered as per order. At 12:15 PM Patient #1's vital signs were as follows: BP 241/112, Pulse 101, Temp 97.8 (Fahrenheit), oxygen saturation 98% (room air), and respiration 20. At 12:37 PM Clonidine 0.1 mg tablet per oral was ordered by Physician #7. At 1:08 PM Patient #1's vital signs were as follows: BP 167/80, Pulse 69, Temperature 97.7 (Fahrenheit), oxygen saturation 95% (room air), and respiration 20. At 1:12 PM Personnel #11 held the Clonidine 0.1 mg tablet per oral due to BP Low, last BP: 167/80 11/14/16 1:08 PM.

Besides blood pressure problems, Patient #1 had other medical and social issues that were unresolved during his ED stay. Hereunder were the unresolved treatment and issues prior to discharge at 2:00 PM on 11/14/16:

1) Patient #1 did not receive a re-evaluation from Physician #7.

2) Patient #1 had Diabetes and had a blood sugar level of 141 which obtained in the ambulance. The blood sugar was not rechecked in the ED and/or blood work was not ordered for Patient #1.

3) Patient #1 had a pain level of 10 on a pain scale of 1 to10 during the initial nursing assessment at 11:07 AM. Upon reassessment at 12:14 PM, Patient #1 verbalized his pain level was a 7 and could be alleviated with pain medication. There was no order for Patient #1's pain management.

4) Physician #7 did not identify Patient #1's home medications. Physician #7 did not know if Patient #1 was compliant or not with his medication regimen for hypertension or Diabetes Mellitus. There was no home medication list found in Patient #1's medical record.

5) Patient #1 was unable to take care of himself. He had problems with moving around and needed maximum assistance. Patient #1 lived in poor living conditions. Patient #1 needed help with his activities of daily living. All these issues were not reported to case management which was available.

Per ED log, Patient #1 returned to the ED on 11/14/16 at 11:19 PM via ambulance for change mental/neuro stat complaint. The Primary Impression was malignant hypertension and was subsequently admitted .

In an interview on 03/27/17 at 3:00 PM and 03/28/17 at 11:30 AM, Physician #7 stated the day Patient #1 presented in the ED it was very busy. He stated he missed documenting Patient #1's re-evaluation. Physician #7 stated he saw Patient #1 about 3 times. Physician #7 stated he did not order pain medications because more than likely Patient #1 did not want pain medications. Physician #7 stated he did not receive report from the nursing staff about the above patient issues.

In an interview on 03/28/17 at 2:25 PM, Personnel #13 was asked if case management services was provided in the ED. She replied that they do. Their names, phone numbers, and daily on-call list were available at the secretary's desk. She explained if they received a report, for example like Patient #1, she would have talked to the nurse and physician to find out what was going on with the patient. She would have talked to Patient #1 and would offer resources and explore all options in order to have a safe discharge.

Based on record review and interview, Hospital A failed to comply with 489.24 (e) (1)-(2) for 1 of 10 patients (Patient #1), in that the Emergency Department (ED) personnel did not contact Hospital B to secure an available bed for the transfer of Patient #1 who was needing a higher level of care. Hospital A directly called the 911 EMS System (Emergency Medical Service) for the transfer of Patient #1 on 11/16/14.

Findings included:

Patient #1 presented in the Hospital A Emergency Department located at North Tarrant Parkway, Fort Worth, TX on 11/16/14 at 6:37 PM for a head injury. From 6:51 PM to 7:00 PM, Physician #8 intubated the patient. Physician #8 noted Disposition...Primary Impression: intracranial hemorrhage, Secondary Impression: Fall, Scalp laceration, Disposition: Transferred...Yes. On 11/16/14 at 7:45 PM the patient left the facility via ambulance. There was no documentation in Patient #1's medical record for the following information: Hospital A called Hospital B to pre-arrange a transfer, physician to physician report was conducted, medical record was sent, and a memorandum of transfer was completed.

In an interview on 12/2/14 at 3:07 PM in Hospital's A Houston conference room via phone, Personnel #6 was asked who called 911 to transfer Patient #1. Personnel #6 replied that she did. Personnel #6 stated this was not the procedure when transferring a patient. Personnel #6 stated the ED protocol was to call the transfer center for transfers of ED patients. Personnel #6 was was asked if a memorandum of transfer was completed. Personnel #6 replied that it was not. This was confirmed by Personnel #4 on 12/2/14 at 8:30 PM via phone.

Hospital A's policy: EMTALA Texas Transfer (Emergency Medical Treatment and Labor Act) reviewed 12/2013 pages 1, 6, and 13 required Any transfer of an individual with an emergency medical condition (EMC) must be initiated by a written request for transfer from the individual...or by a physician order with the appropriate physician certification as required under EMTALA. EMTALA obligations regarding the appropriate transfer of an individual determined to have an EMC apply to any dedicated emergency department of a hospital whether located on or off campus...Any individual who has been medically stabilized may be transferred...pursuant to physician's order via a pre-arranged transfer of treatment plan...and all of the following conditions are met: a. Minimize the Risk...b. Document stable condition...c. Consent...d. Send Medical Records...e. Send Memorandum of Transfer...

Based on record review and interview, Hospital A failed to provide an appropriate transfer for 1 of 10 patients (Patient #1) on 11/16/14, in that, the Emergency Department (ED) personnel did not contact Hospital B to secure available bed for Patient #1 who was needing a higher level of care. Hospital A directly called 911 EMS System (Emergency Medical Service) to transfer Patient #1 on 11/16/14.

Findings included:

Patient #1 presented in the Hospital A Emergency Department located at North Tarrant Parkway, Fort Worth, TX on 11/16/14 at 6:37 PM for a head injury. From 6:51 PM to 7:00 PM, Physician #8 intubated the patient. Physician #8 noted Disposition...Primary Impression: intracranial hemorrhage, Secondary Impression: Fall, Scalp laceration, Disposition: Transferred...Yes. On 11/16/14 at 7:45 PM the patient left the facility via ambulance. There was no documentation in Patient #1's medical record for the following: Hospital A called Hospital B if space and qualified personnel was available for the treatment of Patient #1 and if Hospital B agreed to provide appropriate medical treatment.

In an interview on 12/2/14 at 3:07 PM in Hospital's A Houston conference room via phone, Personnel #6 was asked who called 911 to transfer Patient #1. Personnel #6 replied that she did. Personnel #6 stated this was not the procedure when transferring a patient. Personnel #6 stated the ED protocol was to call the transfer center for transfers of ED patients. Personnel #6 was was asked if a memorandum of transfer was completed. Personnel #6 replied that it was not. This was confirmed by Personnel #4 on 12/2/14 at 8:30 PM via phone.

Hospital B's medical record for Patient #1 dated 11/16/14 reflected HPI - 7:58 PM Patient #1...presents to the ED via EMS as a transfer from Hospital A...Per EMS, patient fell and hit his head...approximately 6:00 PM...While at Hospital A, patient lost consciousness...intubated...Patient did not receive a CT scan. The notation was authored by a physician from Hospital B on 11/16/14 at 7:57 PM.

Hospital A's policy: EMTALA Texas Transfer (Emergency Medical Treatment and Labor Act) reviewed 12/2013 pages 1, 6, and 13 required Any transfer of an individual with an emergency medical condition (EMC) must be initiated by a written request for transfer from the individual...or by a physician order with the appropriate physician certification as required under EMTALA. EMTALA obligations regarding the appropriate transfer of an individual determined to have an EMC apply to any dedicated emergency department of a hospital whether located on or off campus...Any individual who has been medically stabilized may be transferred...pursuant to physician's order via a pre-arranged transfer of treatment plan...and all of the following conditions are met: a. Minimize the Risk...b. Document stable condition...c. Consent...d. Send Medical Records...e. Send Memorandum of Transfer...

Patient Transfer Agreement dated 9/1/12 between Hospital A and Hospital B indicated both parties acknowledged, understood and agreed the following...Responsibilities of the Parties...Notify the receiving Party's designated representative prior to transfer to receive confirmation as to availability of appropriate space, services, and staff necessary to provide care to the Patient...