DOCUMENT NUMBER:

PROCEDURAL POLICY NSD - DC – 1 – 00004

DIVISION: DEPARTMENT: SECTION:
NURSING SERVICE DIVISION SPECIALTY AREA DIALYSIS
SUBJECT: APPROVED BY: EFFECTIVE DATE:

TRANSFER TO ANOTHER ENGR. CELESTINO BALDONADO PAGE 1 of 2

DIALYSIS CENTER PRESIDENT

GENERAL POLICY STATEMENT

This policy is directed towards implementing an established procedure of transferring a patient to

another Dialysis Center of his/her choice to ensure continuity of care and maximum comfort.

Scope

This policy shall apply to all Dialysis Center Staff, Internal Medicine Associate Consultants, Attending
Nephrologist, and the patient.

Purpose

To ensure that a patient transferring to another dialysis center shall be provided with the necessary
instructions and complete medical records for continuity of care.

Procedure

1. The patient informs the dialysis center and his/her attending nephrologist the plan of transfer
2. The Dialysis Center staff and Attending Nephrologist recognize and respect the patient’s decision
to transfer to another dialysis center of his/her choice.
3. Once the plan of transfer is known, the Dialysis Center Head Nurse/Staff Nurse informs the
Attending Nephrologist.
4. The Dialysis Center staff and/or Attending Nephrologist facilitate and ensure proper handing off
(endorsement) of patient.
5. The Dialysis Center staff provides the transferring patient with documents that are necessary to
ensure continuity of care:
5.1. Updated medical abstract that contains the following:
▪ Patient’s general information
▪ Diagnosis and other medical problems
▪ Blood type and history of blood transfusion
▪ Hemodialysis prescription:
Duration and frequency of hemodialysis
Hemodialysis access
Cannulation technique
Anticoagulant
Dialyzer type/size
Prepared by: Recommending Approval: Concurred by:

Alicia Nepomuceno-Baldonado, MD, Judith Ferranco, RN, MANc Eli Florendo, MD, MBA, FPSO-HNS
FPCP, FPSN Chief Nurse Medical Director
Department Head
Noted by:

Maria Ysobelle Grace A. Medina, RN Editha B. Reyes RN, MAN

Unit Head Executive Vice-President
 DOCUMENT NUMBER:
PROCEDURAL POLICY NSD - DC – 1 – 00004
DIVISION: DEPARTMENT: SECTION:
NURSING SERVICE DIVISION SPECIALTY AREA DIALYSIS
SUBJECT: APPROVED BY: EFFECTIVE DATE:

TRANSFER TO ANOTHER ENGR. CELESTINO BALDONADO PAGE 2 of 2

DIALYSIS CENTER PRESIDENT

Dry weight
Blood flow rate and dialysate flow rate
Dialysate bath composition (Na, K, Ca, HCO3 concentration)
 Problems, complications encountered during hemodialysis
 Medications
 Printed name and signature, PRC license number of attending nephrologist or Internal
Medicine Associate Consultant (IM AsCon) or Resident on Duty (ROD)
5.2. Endorsement from the attending nephrologist (if applicable)
5.3. Photocopy of last three hemodialysis treatment record
5.4. Copy of the most recent hepatitis profile (HBsAg, anti-HBs, antiHCV), iron studies, intact
PTH
5.5. Copy of all available and most recent laboratory results or photocopy of tabulated
laboratory results
5.6. Photocopy of printed PhilHealth Dialysis Database (PDD) registration (if applicable)
6. Dialysis Center Staff secures clearance on the release of documents from Dialysis Head Nurse,
Attending Nephrologist, and Medical Records Officer.
7. Patient settles all bills.
8. Patient/caregiver acknowledges all the documents and instructions received.
9. Dialysis Center Staff documents endorsement with accepting dialysis care provider.

RESPONSIBLE AUTHORITIES:
1. Resident On Duty/IM Associate Consultant/Attending Nephrologist
2. Dialysis Head Nurse
3. Dialysis Staff Nurse

Prepared by: Recommending Approval: Concurred by:

Alicia Nepomuceno-Baldonado, MD, Judith Ferranco, RN, MANc Eli Florendo, MD, MBA, FPSO-HNS
FPCP, FPSN Chief Nurse Medical Director
Department Head
Noted by:

Maria Ysobelle Grace A. Medina, RN Editha B. Reyes RN, MAN

Unit Head Executive Vice-President