| Del Norte |
Distribution of paperwork:
- Accepting hospital:
(Copies of the following forms are faxed to the accepting designated Psychiatric Health Facility, designated Acute Psychiatric Hospital, or inpatient psychiatric unit in a General Acute Care Hospital by Del Norte County Behavioral Health Branch staff as part of the referral process; originals are placed in a sealed envelope by Emergency Room staff to accompany individual to the facility)
- Original 5150 form with date and time (NOTE: Original always preferred);
- Original Memorandum of Transfer with date and time;
- Copies of all Laboratory work facesheet, Emergency Room cover sheet, & any pertinent written reports.
- Ambulance: (Copies of the following documents are placed in a sealed envelope by Behavioral Health Branch staff)
- Prescription authorizing transfer with diagnosis and doctor signature;
- Copy of the 5150 form;
- Copy of the Memorandum of Transfer;
- Copy of the facesheet;
- Copies of the remainder of the chart information.
- DNBH: (Copies made by Behavioral Health Branch staff)
- Copies of all above paperwork.
- Hospital: where the individual was originally evaluated: (Copied by Behavioral Health Branch staff)
- Copy of the 5150 form
- Copy of the Memorandum of Transfer
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