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In November 2022, the latest version of the SWCCN Transfer Form has been published. This page provides some information about it and what happens to the data submitted.

About the form

The form is a carbon copy consisting of two ‘front’ pages, one with a red outline (that is placed in the receiving hospital patient notes) and one with a blue outline (below, that is returned to the SWCCN). Click the images below for larger versions.

On the back of page 2, there are a series of checklists, a risk assessment and useful information including physiological parameters, useful telephone numbers and a QR code link to the Retrieve SOPs and Emergency Action Cards.

What has changed

The form has been completely redesigned to be as user-friendly as possible and to follow a logical pattern as you prepare and then undertake a transfer. 

When should we use the new form?

Please start to use these forms immediately.  Please share this document with anyone who undertakes transfers from your hospital (e.g. anaesthesia and intensive care trainees and consultants, etc).

We suggest you distribute them throughout ICU, ED and anywhere else inter-hospital transfers regularly originate. 

When you need additional copies, please contact the SWCCN who will post them to you. 

What shall I do with any old forms?

Please destroy any unused old transfer forms.

If you have any completed old forms, please send these on to the SWCCN at the address printed on the forms. 

What happens to the forms and data?

All completed forms should be returned by post to the SWCCN (address on the bottom of the form). 

The data is then transcribed into Retrieve’s database and a digital copy of the form retained. This data is treated in the same way as any other patient-identifiable data stored by Retrieve.

This will enable much higher quality case review, thematic review and identification of logistical/operational elements of transfers that can be shared and collaboratively worked upon. 


If you have any questions about the form, or suggestions for subsequent revisions, please get in touch.