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Internal Medicine Specialist Template

Tele-Transfer Note

A professional Internal Medicine Specialist template for healthcare professionals.
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Specialty

Internal Medicine Specialist

Used

7 times

Type

Note

Last edited

11/13/2025

Created by

Matthew Fabiszak

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About this template

The Tele-Transfer Note template is a crucial tool for internal medicine specialists and other healthcare providers involved in patient transfers between facilities. This template ensures comprehensive documentation of the patient's condition, treatment history, and immediate needs, facilitating seamless communication between the transferring and receiving teams. It includes sections for vital signs, medical history, and actionable items upon arrival, making it an essential resource for efficient and safe patient handovers. This template is particularly useful in scenarios where specialized care is required that is not available at the originating facility.

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1. Originating Facility Name and Provider/Title St. Mary's Hospital, Dr. John Smith, MD 2. Reason for transfer and consultants involved The patient requires specialized cardiac surgery not available at St. Mary's Hospital. Dr. Emily Brown, Cardiologist, has been consulted. 3. Brief HPI The patient, a 65-year-old male, was admitted on 28 October 2024 with a chief complaint of chest pain and shortness of breath. The hospital course included stabilization with medication and monitoring. Past Medical History: Hypertension, Type 2 Diabetes. Home Medications: Lisinopril, Metformin. Allergies: Penicillin. 4. Last vital signs and pertinent vital trends Temperature: 98.6°F Heart rate: 88 bpm Blood pressure: 140/85 mmHg Respiratory rate: 18 breaths/min SpO2: 95% on room air 5. Pertinent exam per doc-to-doc The patient is alert and oriented, with clear lung sounds and regular heart rhythm. 6. Pertinent labs and imaging Complete blood count: WBC 7.0, Hemoglobin 13.5, Platelets 250 Metabolic panel: Sodium 140, Potassium 4.2, Creatinine 1.0 Chest X-ray: No acute findings 7. Medication and therapy administered Aspirin, Nitroglycerin, and IV fluids administered. 8. Assessment of patient's immediate clinical situation and actionable items needed upon arrival The patient is stable but requires immediate evaluation by the cardiac surgery team upon arrival. Notify Dr. Emily Brown upon patient's arrival. 9. Receiving floor, facility, accepting physician Dr. Michael Green, Cardiac Surgery Unit, City General Hospital, 5th Floor

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