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SNF/NH Transfer to MMC ED


The forms on this page are to be used for the SNF/NH to MMC ED patient transfer process. Maine Medical Center's Emergency Department and North East Mobile Health Services are partnering with the participating homes listed below. 

Pam Jordan
North East Mobile Health Services
Polly Miller
Homes (Phase 1)
Barron Center
Ed Latham
Gorham House
Gail Hauser
Seaside Rehabilitation and Healthcare Center
Danielle Sullivan 
Homes (Phase 2)
The Cedars    
Sue Dionne-Jones
Falmouth by the Sea    
Lindsay Brown
St. Joseph's Rehabilitation and Residence    
Bonnie Smith


MaineHealth Contact:
Sharon Foerster, 207-661-7595

As you use the forms, feel free to provide feedback to Sharon Foerster in between meetings.

** Immediate communication is expected if the process adversely affects patient care in any way. **

Pilot Process Map
This is an overview of the current process, with flagged areas for improvement/change.

To be used by the SNF/NH, ED, OneCall and/or EMS.

Transfer to ED Document Checklist
This form is placed on the outside of the manila envelope.


Resident Transfer Form
This form is placed inside the manila envelope and includes most important resident information.


SBAR Forms

(1) One-Page SBAR Document



(2) INTERACT® SBAR Form This form is also available on the INTERACT® website. Please note that you must go to the INTERACT® website and agree to use the INTERACT® Licensed Materials as described in the terms of agreement. Seaside uses their own SBAR format which comes out of their electronic record.

Homes might use their own type of form to document the SBAR communication.

OneCall Form

This form includes the bullets of what the SNF/NH clinician will tell the OneCall staff and/or what the OneCall person will ask during the call.
Transfer Form - ED Discharge to Nursing Home
This form was created by the MMC ED.
Face Sheet
This form will be specific to each SNF/NH but contains standard information.
Current MAR
This form will be specific to each SNF/NH documentation.
Advance Directives and Code Status Documentation
Will be what the SNF/NH has on record for the resident. The POLST form will be a state form if the resident has previously filled one out.

Data Tracking Form

This form is to be used by the MMC ED and the SNFs. Staff from any location (SNF, ED, OneCall, EMS and MaineHealth) can use this form to track data and document comments.






Phase 3 Pilot with Pen Bay

110 Free Street | Portland, Maine 04101 | (207) 661-7001