Patient Transfer Reporting Form - California

(as of the date of this report) 2472 hours - 8-14 days 4-7 days Over 14 days 4. Final Disposition or status of patient if not released from the hospital within 24 hours * – check appropriate box Patient sent home Patient died Patient still in hospital Other Patient transferred to SNF/Rehab. facility 5. Physician’s Practice Specialty and.

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