Inpatient Transfer and Return Agreement (PDF)
In order to continue to meet the needs of all Georgia children who require pediatric, tertiary-level services, Children's has implemented a policy to obtain commitment from transferring hospitals to only transfer those patients who require services that the transferring hospital cannot provide and agree to promptly accept the return of such patients once the Children's specialized services have been rendered.
Such commitment will be obtained through completion of an Inpatient Transfer and Return Agreement form by an authorized representative of the referring hospital for any inpatient transfer to Children's. The referring hospital will be responsible for identifying the individuals accountable for signing, even during evening and weekend hours.
Children's will not delay the transfer of patients with an emergent need for services, but will request the prompt return of the completed form as soon as possible after the initiation of the transfer. Transfer of patients for scheduled services and/or non-emergent services will be accepted only after return of the signed form to the Children's Transfer Center and after payor authorization has been verified.
The decision whether an interfacility transfer is emergent or non-emergent is a physician decision. This is best accomplished when both the referring physician and the accepting physician at Children's are on the phone together with the registered nurse in the Transfer Center documenting the agreed upon decision. This decision will then initiate the correct authorization process.