Bed Hold Notification Tracking Log

Tracks bed hold notices provided at the time of hospital transfer, including notice delivery, recipient, resident right to return, and follow-up status.

Transfer and Resident Identification

• Resident Full Name
• Room / Unit Number
• Date of Hospital Transfer
• Time of Transfer
• Receiving Hospital / Facility
• Reason for Transfer
• If 'Other', specify reason
• Staff Member Completing This Log

Bed Hold Notice Delivery

• Was the bed hold notice provided at the time of transfer?
• Reason notice was not provided or only attempted
• Notice Delivered To
• Recipient Name
• Recipient Relationship to Resident
• Method of Notice Delivery
• Date and Time Notice Was Delivered
• Did the recipient acknowledge receipt of the notice?

Bed Hold Policy and Duration

• Resident's Primary Payer Source
• Bed Hold Duration Communicated (number of days)
  Enter the number of days the bed will be held per facility policy and applicable payer rules.
• Bed Hold Expiration Date
  Date on which the bed hold period ends and the bed may be reassigned if resident has not returned.
• Is Medicaid bed hold payment applicable for this resident?
• Was a written copy of the facility's bed hold policy provided?

Resident Right to Return

• Was the resident/representative informed of the resident's right to return to the facility?
• Were the conditions for return explained? (e.g., bed availability if hold expires, readmission criteria)
• Did the resident or representative express intent to return?
• Additional Notes on Right-to-Return Discussion

Follow-Up, Escalation, and Audit Trail

• Date of First Follow-Up Contact Attempt
• Follow-Up Contact Method
• Follow-Up Contact Outcome
• Current Bed Hold Status
• Date Resident Returned to Facility
• Was escalation to the Administrator or Social Services required?
• Escalation Details
• Has a copy of this log been filed in the resident's medical record?
• Additional Notes or Observations