Is a signed transfer form required under Emergency Medical Treatment and Active Labor Act (EMTALA) for an inpatient transfer to a different hospital?

EMTALA Requirements for Inpatient Transfers Between Hospitals

EMTALA does not require a signed transfer form for inpatients being transferred to a different hospital, as EMTALA obligations generally end once a patient is admitted as an inpatient.

Understanding EMTALA's Scope

EMTALA (Emergency Medical Treatment and Active Labor Act) was originally designed to prevent "patient dumping" - the practice of refusing emergency care to patients for economic reasons, particularly those who are uninsured or unable to pay 1. The law primarily applies to:

1. Patients presenting to the emergency department (ED)
2. Patients in active labor
3. Patients with emergency medical conditions requiring stabilization

When EMTALA Applies vs. When It Doesn't

EMTALA obligations include:

• Providing appropriate medical screening examinations
• Stabilizing emergency medical conditions within the hospital's capability
• Appropriate transfer when necessary for higher level care

For inpatients specifically:

• Once a patient has been admitted as an inpatient, EMTALA obligations generally end
• Regular medical staff bylaws and hospital policies govern inpatient transfers, not EMTALA
• The hospital has already fulfilled its EMTALA obligation by admitting the patient

Transfer Documentation Requirements

While EMTALA documentation is not required for inpatient transfers, good medical practice still dictates proper documentation:

• Physician-to-physician communication should be documented
• The reason for transfer should be clearly stated
• The accepting physician and facility should be documented
• The patient's condition and treatments should be summarized
• A physician order for transfer should be written in the medical record 1

Special Circumstances

There are limited situations where EMTALA considerations might still apply:

1. Transfers for higher level of care: When an inpatient develops an emergency medical condition that requires specialized capabilities not available at the current facility 1

2. Hospitals with specialized capabilities: These facilities have a responsibility to accept transfers when necessary to stabilize emergency medical conditions, regardless of the patient's insurance status 1

Common Pitfalls to Avoid

• Misunderstanding EMTALA's scope: Assuming EMTALA applies to all hospital transfers rather than primarily ED patients
• Confusing hospital policy with federal law: Many hospitals have transfer policies that exceed EMTALA requirements
• Financial screening before transfer: This remains prohibited and can result in penalties 2
• Inadequate documentation: While EMTALA forms aren't required for inpatients, proper transfer documentation is still essential for continuity of care

Best Practices for Inpatient Transfers

1. Follow your hospital's transfer protocols
2. Ensure physician-to-physician communication
3. Document medical necessity for transfer
4. Obtain informed consent when possible
5. Provide complete medical records to the receiving facility
6. Arrange appropriate transportation based on patient needs

Remember that while EMTALA doesn't require signed transfer forms for inpatients, your hospital policy might have additional requirements that exceed federal regulations.