REMEMBER: Patient cannot be referred or shifted unless a DMS - to - DMS communication has been done, or communication has been done with the consultant in the ward on the receiving end, use referral proforma that must be signed by Onduty RESIDENT, Senior Registrar, and DMS of the hospital from where the baby is being shifted.
> Case summary (discussed below) will be handed over to the doctors on receiving end, photocopies of laboratory test results may be provided to them, Patient Chart or its copy will not be given to attendants or the receiving doctors, it is our hospital property.
Documentation for shifting of baby:
PRESHIFTING
Date of referral __________
Time of referral __________
Name of the hospital where being shifted:____________________
Dr on duty at that hospital who confirmed the request to shift the baby:____________________
Baby Name __________
Pre shifting vital signs: HR __________ RR __________ spo2__________ temperature __________ CRT __________ BSR __________
Prepare case summary of the baby that should include detailed history, examination findings, issues over time and management done, investigations summary, treatment given, and reason for shifting.
This case summary will be handed over to the doctor on the receiving end.
Accompanying healthcare professionals' names
1. ________
2. ________
Equipment/drugs taken along during shifting:
1.__________
2.__________
3.__________
4.__________
5.__________
6.__________
7.__________
8.__________
DURING SHIFTING
Any issues encountered during shifting:
1. patient related:
2. Vehicle related
3. any other:
AFTER SHIFTING
Name of the doctor at the receiving end:___________
Time of receiving the patient
Vitals signs at handover:
Heart rate __________ RR__________ spo2__________ temperature __________ CRT __________
Name of doctor documenting the notes:__________
signs __________ date __________ time __________
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