Capture patient information for transfer/referral and/or discharge summary for non-OASIS patient discharges. May also be used to analyze reasons for discharge and transfer/referral, and trend thisinformation. Can also beused to collect data for length of stay and retrospective record reviews.

8 1/2" x 11" (detached), 2-part carbonless snap set, white original, canary copy, black ink, standard 5-hole punched top and side, wrapped in 100s.