Interfacility Transfer Policies – Del Norte County

Behavioral Health Branch uses Del Norte Ambulance, or other secured transport,for all 5150 transfers, including minors (parent/guardian is allowed to ride in ambulance with minor).

Transfer documentation shall be completed by the Emergency Room attending nurse and attending physician.

The attending physician shall complete his/her portion of the Memorandum of Transfer, along with a prescription for the ambulance.

The attending nurse shall complete his/her appropriate portion of the Memorandum of Transfer.

Once a designated Psychiatric Health Facility, designated Acute Psychiatric Hospital, or inpatient psychiatric unit in a General Acute Care Hospital has accepted the individual, Crisis staff shall arrange for transportation to the accepting facility. 

Crisis staff shall notify the Emergency Room staff if they believe that the individual is potentially assaultive or an elopement risk. It is the responsibility of the Emergency Room staff to manage staff and patient safety issues.

Crisis staff may leave the Emergency Room as soon as:

• A psychiatric facility has accepted the individual, and
• Emergency Room staff have been informed of the placement, and
• All relevant documentation has been completed.
• Crisis staff will return to ensure client is transported to Psych Facility

It is the responsibility of the Behavioral Health Branch Crisis Worker to conclude the transfer of the individual, including completion and distribution of the transfer paperwork; accompanying the individual to the ambulance; and notifying the accepting facility of the individual‘s estimated time of arrival.

The original 5150 is preferred. However, a copy is legally equivalent.

Del Norte Ambulance bills the individual(s) insurance directly