Page Comparison

Receiving Facility

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162724AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA161562 Name of where the patient was referred to

Transfer-Out Date (Date transfer-out takes effect)

␣␣-␣␣-␣␣␣␣ 📆

160649AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA160649 Date transferred out

Transfer-out Verified

🔘 Yes

🔘 No

🔘 Unknown797e0073-1f3f-46b1-8b1a-8cdad134d2b3

169465 Transfer out verification complete

• 1065 Yes

• 1066 No

• 1067 Unknown

Date verification done

␣␣-␣␣-␣␣␣␣ 📆

160753AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA169466 Datetime of verification

Notes

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165095AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA160632 Free text general