CMS SOM App. W, Tag C-2409

If an individual at a hospital has an emergency medical condition that has not been

stabilized (as defined in paragraph (b) of this section), the hospital may not transfer the

individual unless –

(i) The transfer is an appropriate transfer (within the meaning of paragraph (e)(2) of

this section); and

(ii)(A) The individual (or a legally responsible person acting on the individual's behalf)

requests the transfer, after being informed of the hospital's obligations under this

section and of the risk of transfer.

The request must be in writing and indicate the reasons for the request as well as

indicate that he or she is aware of the risks and benefits of the transfer.

(B) A physician (within the meaning of section 1861(r)(1) of the Act) has signed a

certification that, based upon the information available at the time of transfer, the

medical benefits reasonably expected from the provision of appropriate medical

treatment at another medical facility outweigh the increased risks to the individual or,

in the case of a woman in labor, to the woman or the unborn child, from being

transferred. The certification must contain a summary of the risks and benefits upon

which it is based; or

(C) If a physician is not physically present in the emergency department at the time an

individual is transferred, a qualified medical person (as determined by the hospital in

its bylaws or rules and regulations) has signed a certification described in paragraph

(e)(1)(ii)(B) of this section after a physician (as defined in section 1861(r)(1) of the Act)

in consultation with the qualified medical person, agrees with the certification and

subsequently countersigns the certification. The certification must contain a summary

of the risks and benefits upon which it is based.

(2) A transfer to another medical facility will be appropriate only in those cases in

which –

(i) The transferring hospital provides medical treatment within its capacity that

minimizes the risks to the individual's health and, in the case of a woman in labor, the

health of the unborn child;

(ii) The receiving facility

(A) Has available space and qualified personnel for the treatment of the individual;

and

(B) Has agreed to accept transfer of the individual and to provide appropriate medical

treatment.

(iii) The transferring hospital sends to the receiving facility all medical records (or

copies thereof) related to the emergency condition which the individual has presented

that are available at the time of the transfer, including available history, records

related to the individual's emergency medical condition, observations of signs or

symptoms, preliminary diagnosis, results of diagnostic studies or telephone reports of

the studies, treatment provided, results of any tests and the informed written consent or

certification (or copy thereof) required under paragraph (e)(1)(ii) of this section, and

the name and address of any on-call physician (described in paragraph (g) of this

section) who has refused or failed to appear within a reasonable time to provide

necessary stabilizing treatment. Other records (e.g., test results not yet available or

historical records not readily available from the hospital's files) must be sent as soon as

practicable after transfer; and

(iv) The transfer is effected through qualified personnel and transportation equipment,

as required, including the use of necessary and medically appropriate life support

measures during the transfer.