Based on a review of facility policy, medical records (MR), and staff interviews (EMP), it was determined the facility failed to ensure their policy met the Emergency Medical Treatment and Labor Act regulations that required the On-Call Specialist to fulfill the on-call obligations as required by the regulations. Findings include: A review of facility policy "Pinnacle Health Hospitals Department of Emergency Services, review date 5/17" revealed "Subject: On-Call Specialist...6. In the following circumstances, an EMTALA appropriate transfer process may be initiated:...b. The on-call specialist refuses to appear as requested...d. Prior to initiating the transfer process, the Chairman of the on-call specialist's department and/or the appropriate Vice President of Medical Affairs may be contacted for possible assistance in obtaining the desired consult. &. The Center for Medicare and Medicaid services(CMS) has ruled that according to EMTALA, the on-call specialists must defer to a request by an emergency physician or practitioner who had personally examined and is currently treating the patient, to appear and evaluate the patient. If a patient is transferred because the on-call specialist refuses to appear as requested, the emergency physician should write the name and address of the on-call specialist who refused to appear as requested on the transfer sheet..." A review of the MR1 revealed "HPI Comments: Patient states around 11:00 PM he put in 8 inch makeup brush into his urethra. It became lodged he could not get it out. States he could not urinate...Physical Exam:...Genitourinary : Penis normal. No penile tenderness. Genitourinary Comments: No foreign bodies visualized in the penis...ED Course: MDM 2:54 AM I contacted Dr. [name redacted] from Urology. He states that he 'has had only 1 hour sleep.' "he has 3 cases scheduled for tomorrow." "this might be trauma and I am not comfortable taking care of it. You need to send to Hershey." 3:06 AM I did contact Hershey Medical Center, Dr. [name redacted] was accepting physician. The patient Will have transportation arranged..." An interview conducted on September 18, 2017, with EMP4 revealed that EMP4 was on-call for the Urology services that night. EMP4 had been up all night doing surgery. Further interview revealed that EMP4 does not do urethra surgery and if urethra surgery was needed they (the patient ) would be better served at Hershey. An interview conducted on September 18, 2017, with EMP5 revealed that EMP5 (a physician) was not aware of the event. EMP5 stated that this is not uncommon to see in patients, we usually remove the foreign body with a scope. We get called to come in and assess the patient and at the very least put a scope down. Any physician that is board certified in Urology should be able to put a scope down. If the urethra is damaged we are trained to put a tube directly into the bladder. Our protocol is to call another physician in the group. We always have a backup on call. The back up was not called that night. Further interview with EMP5 revealed, the patient "Did not have to be transferred until he was assessed. We typically come in and assess, put in a scope to determine the next step. An On-Call physician is required to go to the hospital to examine the patient when called " Cross reference with: 489.20(l) Compliance with 482.24- 489.20(l) 489.20(r)(2) and 489.24(j)(1-2) On Call Physicians 489.20(r)(2) and 489.24(e)(1)-(2) Appropriate Transfer

Based on a review of facility policy, medical records (MR), and staff interviews (EMP), it was determined the facility failed to be in compliance with EMTALA regulation 489.20 (l) related to appropriate transfers. Findings include: It was determined the physicians failed to sign 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. The certification must contain a summary of the risks and benefits upon which it is based for 20 of 43 medical records reviewed. (MR4, MR5, MR11, MR13, MR16, MR22, MR24, MR26, MR27, MR31, MR32, MR33, MR34, MR36, MR38, MR39, MR40, MR41, MR42 and MR43) and failed to document that a copy of the medical record accompanied the patient for 14 of 43 medical records reviewed. (MR4, MR5, MR13, MR16, MR 22, MR24, MR27, MR31, MR34, MR36, MR38, MR39, MR41 and MR43) A review of facility policy "Pinnacle Health Hospitals Department of Emergency Services, last reviewed 5/17" revealed "Subject: Patient transfer from Emergency Department to Another Health Care Facility. Policy Statement: The Department of Emergency Medicine will provide for the proper transfer of patients in accordance with the Emergency Medical Treatment and Active Labor Act (EMTALA)...3. The following requirement must be met prior to transfer: a. The PHH (Pinnacle Health Hospitals) Emergency Department must provide treatment, within its capacity, that minimizes risk to the patient's health, and in the case of a woman in labor, the health of the unborn child...e. The patient consent for transfer form (Attachment A) has been completed collaboratively between the nursing and the physician staff..." A review of MR4 revealed the patient was seen in the Emergency Department on November 25, 2016, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR5 revealed the patient was seen in the Emergency Department on August 22, 2017, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR11 revealed the patient was seen in the Emergency Department on October 22, 2016, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR13 revealed the patient was seen in the Emergency Department on December 18, 2016, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR16 revealed the patient was seen in the Emergency Department on July 29, 2017, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR22 revealed the patient was seen in the Emergency Department on August 13, 2017, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR24 revealed the patient was seen in the Emergency Department on May 7, 2017, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR26 revealed the patient was seen in the Emergency Department on March 8, 2017, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR27 revealed the patient was seen in the Emergency Department on October 5, 2016, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR31 revealed the patient was seen in the Emergency Department on March 13, 2017, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR32 revealed the patient was seen in the Emergency Department on November 14, 2016, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR33 revealed the patient was seen in the Emergency Department on January 23, 2017, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR34 revealed the patient was seen in the Emergency Department on November 16, 2016, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR36 revealed the patient was seen in the Emergency Department on December 24, 2016, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR38 revealed the patient was seen in the Emergency Department on July 3, 2016, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR39 revealed the patient was seen in the Emergency Department on November 5, 2016, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR40 revealed the patient was seen in the Emergency Department on October 10, 2016, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR41 revealed the patient was seen in the Emergency Department on December 18, 2016, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR42 revealed the patient was seen in the Emergency Department on February 20, 2017, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR43 revealed the patient was seen in the Emergency Department on August 18, 2017, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. Interviews conducted on September 19 and 20, 2017, with EMP3 confirmed the medical records did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. _____________________________ A review of facility policy "Pinnacle Health Hospitals Department of Emergency Services, last reviewed 5/17" revealed "Subject: Patient transfer from Emergency Department to Another Health Care Facility. Policy Statement: The Department if Emergency Medicine will provide for the proper transfer of patients in accordance with the Emergency Medical Treatment and Active Labor Act (EMTALA)...3. The following requirements must be met prior to transfer:... c. All pertinent and available records are copied and sent with the patient being transferred outside of the Pinnacle Health System..." A review of MR4 revealed the patient was seen in the Emergency Department on November 25, 2016, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. A review of MR5 revealed the patient was seen in the Emergency Department on August 22, 2017, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. A review of MR13 revealed the patient was seen in the Emergency Department on December 18, 2016, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. A review of MR16 revealed the patient was seen in the Emergency Department on July 29, 2017, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. A review of MR22 revealed the patient was seen in the Emergency Department on August 13, 2017, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. A review of MR24 revealed the patient was seen in the Emergency Department on May 5, 2017, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. A review of MR27 revealed the patient was seen in the Emergency Department on October 5, 2016, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. A review of MR31 revealed the patient was seen in the Emergency Department on March 13, 2017, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. A review of MR34 revealed the patient was seen in the Emergency Department on November 16, 2016, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. A review of MR36 revealed the patient was seen in the Emergency Department on December 24, 2017, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. A review of MR38 revealed the patient was seen in the Emergency Department on July 3, 2017, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. A review of MR39 revealed the patient was seen in the Emergency Department on November 5, 2016, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. A review of MR41 revealed the patient was seen in the Emergency Department on December 18, 2016, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. A review of MR43 revealed the patient was seen in the Emergency Department on August 18, 2017, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. Interview conducted on September 19 and 20, 2017, with EMP3 confirmed the medical records did not contain documentation that a copy of the medical record accompanied the patient upon transfer. Cross reference with: 489.20 (r)(2) and 489.24 (e)(1)-(2) Appropriate Transfer

Based on review of medical record (MR1) and staff interview (EMP), it was determined the physician on-call failed to fulfill the on-call obligations. Findings include: A review of the "Medical Staff By laws, Policies, and Rules and Regulations of The Pinnaclehealth Hospitals, Clinical Practice Rules and Regulations, revised 09/2016," revealed "...Article 6, Emergency Services Section, 6. B. Practitioner Staffing: Because of the broad nature of clinical problems that are seen and treated in an Emergency Department setting, it is necessary for the Hospital and individual Members of the Medical Staff to share in the responsibility for providing the necessary and appropriate Practitioner staffing. The responsibility for staffing shall be delegated as follows: (1) The Hospital will arrange for twenty-four (24) hour coverage in the Emergency Department by Practitioners with special training and/or expertise in Emergency Medicine. Said staff shall be sufficient to handle the normal case load in a reasonable and cost efficient manner. (2) The Medical Staff through its clinical department/sections shall provide specialty and subspecialty coverage as needed, on an "on-call" basis. Each department or section shall develop an "on-call" schedule which will provide adequate Emergency Department coverage...6. E. On Call Services: The duties and responsibility of a Medical Staff Member who is providing specialty and sub-specialty on-call services shall, at a minimum, include the following: (1) When the on-call specialist or sub-specialist is specifically requested by a physician to see a patient in the Emergency Department, the on-call specialist or sub-specialist shall respond in person(or by approved Telemedicine link) and in a timely manner..." The review of MR1 revealed "HPI Comments: Patient states around 11:00 PM he put in 8 inch makeup brush into his urethra. It became lodged he could not get it out. States he could not urinate...Physical Exam:...Genitourinary : Penis normal. No penile tenderness. Genitourinary Comments: No foreign bodies visualized in the penis...ED Course: MDM 2:54 AM I contacted DR ______(name redacted) from Urology. He states that he "has had only 1 hour sleep." "he has 3 cases scheduled for tomorrow." "this might be trauma and I am not comfortable taking care of it. You need to send to Hershey." 3:06 AM I did contact Hershey Medical Center, Dr. ______(name redacted) was accepting physician. The patient Will have transportation arranged..." Review of the "Imaging Results" revealed "...Procedure Performed: CT abdomen pelvis without contrast...Exam Date & Time: 09/06/2017 2:03 AM...History: Foreign body. Put in 8 inch make and brushing into his urethra and it became lodged...Urinary Bladder: There is an 8 inch makeup brush lodged within the distal urethra traversing the prostatic urethra and extending into the bladder. Bladder is intact...Impression: there is an 8 inch makeup brush lodged within the distal urethra traversing the prostatic urethra and extending into the bladder. Urology consultation needed..." A review of the "ER and Consult Coverage for September 2017", revealed that the emergency room Physician called the Physician that was covering for September 5, 2017. An interview with EMP3 revealed that the "on-call" would start at midnight September 5 2017 until midnight September 6, 2017. An interview conducted on September 18, 2017, at 11:00 AM with EMP4 revealed that EMP4 was on-call for the Urology services that night. EMP4 had been up all night doing surgery. Further interview revealed that EMP4 does not do urethra surgery and if urethra surgery was needed they (the patient ) would be better served at Hershey. An interview conducted on September 18, 2017, at 11:30 AM with EMP5 (a physician), revealed that EMP5 was not aware of the event. EMP5 stated that this is not uncommon to see in patients, we usually remove the foreign body with a scope. We get called to come in and assess the patient and at the very least put a scope down. Any physician that is board certified in Urology should be able to put a scope down. If the urethra is damaged we are trained to put a tube directly into the bladder. Our protocol is to call another physician in the group. We always have a backup on call. The back up was not called that night. Further interview with EMP5 revealed, the patient "Did not have to be transferred until he was assessed. We typically come in and assess, put in a scope to determine the next step." Cross reference with: 482.55(a)(3) Emergency Services Policies 489.20(l) Compliance with 482.24- 489.20(l) 489.20(r)(2) and 489.24(e)(1)-(2) Appropriate Transfer

Based on review of facility policy, medical records, and staff interview (EMP), it was determined the physicians failed to sign 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. The certification must contain a summary of the risks and benefits upon which it is based for 20 of 43 medical records reviewed. (MR4, MR5, MR11, MR13, MR16, MR22, MR24, MR26, MR27, MR31, MR32, MR33, MR34, MR36, MR38, MR39, MR40, MR41, MR42 and MR43) and failed to document that a copy of the medical record accompanied the patient for 14 of 43 medical records reviewed. (MR4, MR5, MR13, MR16, MR 22, MR24, MR27, MR31, MR34, MR36, MR38, MR39, MR41 and MR43) Findings include: A review of facility policy "Pinnacle Health Hospitals Department of Emergency Services, last reviewed 5/17" revealed "Subject: Patient transfer from Emergency Department to Another Health Care Facility. Policy Statement: The Department of Emergency Medicine will provide for the proper transfer of patients in accordance with the Emergency Medical Treatment and Active Labor Act (EMTALA)...3. The following requirement must be met prior to transfer: a. The PHH (Pinnacle Health Hospitals) Emergency Department must provide treatment, within its capacity, that minimizes risk to the patient's health, and in the case of a woman in labor, the health of the unborn child...e. The patient consent for transfer form (Attachment A) has been completed collaboratively between the nursing and the physician staff..." A review of MR4 revealed the patient was seen in the Emergency Department on November 25, 2016, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR5 revealed the patient was seen in the Emergency Department on August 22, 2017, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR11 revealed the patient was seen in the Emergency Department on October 22, 2016, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR13 revealed the patient was seen in the Emergency Department on December 18, 2016, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR16 revealed the patient was seen in the Emergency Department on July 29, 2017, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR22 revealed the patient was seen in the Emergency Department on August 13, 2017, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR24 revealed the patient was seen in the Emergency Department on May 7, 2017, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR26 revealed the patient was seen in the Emergency Department on March 8, 2017, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR27 revealed the patient was seen in the Emergency Department on October 5, 2016, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR31 revealed the patient was seen in the Emergency Department on March 13, 2017, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR32 revealed the patient was seen in the Emergency Department on November 14, 2016, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR33 revealed the patient was seen in the Emergency Department on January 23, 2017, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR34 revealed the patient was seen in the Emergency Department on November 16, 2016, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR36 revealed the patient was seen in the Emergency Department on December 24, 2016, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR38 revealed the patient was seen in the Emergency Department on July 3, 2016, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR39 revealed the patient was seen in the Emergency Department on November 5, 2016, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR40 revealed the patient was seen in the Emergency Department on October 10, 2016, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR41 revealed the patient was seen in the Emergency Department on December 18, 2016, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR42 revealed the patient was seen in the Emergency Department on February 20, 2017, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. A review of MR43 revealed the patient was seen in the Emergency Department on August 18, 2017, and was transferred to a different hospital for additional care. The medical record did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. Interviews conducted on September 19 and 20, 2017, with EMP3 confirmed the medical records did not contain a signed physician certification indicating the reason for transfer and the risks and benefits of the transfer. _____________________________ A review of facility policy "Pinnacle Health Hospitals Department of Emergency Services, last reviewed 5/17" revealed "Subject: Patient transfer from Emergency Department to Another Health Care Facility. Policy Statement: The Department if Emergency Medicine will provide for the proper transfer of patients in accordance with the Emergency Medical Treatment and Active Labor Act (EMTALA)...3. The following requirements must be met prior to transfer:... c. All pertinent and available records are copied and sent with the patient being transferred outside of the Pinnacle Health System..." A review of MR4 revealed the patient was seen in the Emergency Department on November 25, 2016, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. A review of MR5 revealed the patient was seen in the Emergency Department on August 22, 2017, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. A review of MR13 revealed the patient was seen in the Emergency Department on December 18, 2016, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. A review of MR16 revealed the patient was seen in the Emergency Department on July 29, 2017, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. A review of MR22 revealed the patient was seen in the Emergency Department on August 13, 2017, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. A review of MR24 revealed the patient was seen in the Emergency Department on May 5, 2017, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. A review of MR27 revealed the patient was seen in the Emergency Department on October 5, 2016, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. A review of MR31 revealed the patient was seen in the Emergency Department on March 13, 2017, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. A review of MR34 revealed the patient was seen in the Emergency Department on November 16, 2016, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. A review of MR36 revealed the patient was seen in the Emergency Department on December 24, 2017, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. A review of MR38 revealed the patient was seen in the Emergency Department on July 3, 2017, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. A review of MR39 revealed the patient was seen in the Emergency Department on November 5, 2016, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. A review of MR41 revealed the patient was seen in the Emergency Department on December 18, 2016, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. A review of MR43 revealed the patient was seen in the Emergency Department on August 18, 2017, and was transferred to a different hospital for additional care. The medical record did not contain documentation that a copy of the medical record accompanied the patient upon transfer. Interview conducted on September 19 and 20, 2017, with EMP3 confirmed the medical records did not contain documentation that a copy of the medical record accompanied the patient upon transfer. Cross reference with: 482.55(a)(3) Emergency Services Policies 489.20(l) Compliance with 482.24- 489.20(l) 489.20(r)(2) and 489.24(j)(1-2) On Call Physicians