ED Transfer Form

Transfer Checklist: Safety Patient wearing mask Patient hand hygiene prior to transfer Patient ambulatory and stable (able to walk 3 blocks)

Communication Checklist: RCH ED notified Discussed with Provider: NP swab done at clinic? ED Transfer Form submitted, and patient provided with copy

Clinical Notes: Cough Fever Coryza Dyspnea Chest pain Recent travel Contact with confirmed COVID case

ED Triage Orders: CBC, Electrolytes, CRP Blood cultures Portable CXR NP swab for: COVID-19 Influenza