Based on review of facility documentation, medical records (MR) and staff interviews (EMP) it was determined the facility failed to obtain approval from an accepting physician prior to transferring one of eleven patients (MR1) and failed to ensure copies of the medical record were sent to the receiving hospital for two of eleven transferred patients (MR2 and MR4). Findings include: Review on January 24, 2019 of UPMC Susquehanna facility policy "Emergency Medical Condition and Stabilization EMTALA," last approved February 2018, revealed "Purpose To establish guidelines to assure that patients who present to a UPMC Susquehanna facility for treatment are offered medical stabilization within the capabilities of the hospital prior to being transferred or discharged to another campus or institution ... Process ... B. Prior to transferring an individual to another medical facility, it will be confirmed: 1. The individual receives medical treatment within the capabilities of the UPMC Susquehanna Campus to minimize risks to the patient's health or the health of an unborn child if a woman is in labor. 2. The physician will call the receiving facility and document that the facility: a. has available space; specific location may be determined upon patient ' s arrival at the institution; b. has qualified personnel; c. agrees to accept the patient and provide treatment. 3. UPMC Susquehanna will send the receiving medical facility copies of all medical records related to the individual's emergency condition, which are available at the time of transfer. Records should include: a. information related to the emergency condition; b. observations of signs and symptoms; c. preliminary diagnosis; d. treatment provided; e. results of any tests; f. the individual or responsible party's consent to transfer or request for transfer; g. the name of any on-call physicians utilized in the care of the patient; h. the name of any on-call physician unwilling or who had failed to appear in a reasonable time to provide necessary stabilizing care. 4. If the circumstances prevent any records from being provided at time of transfer, information will be expeditiously provided thereafter. Information can be faxed to receiving institution .... " Review on January 24, 2019, of facility form "Transfer Consent" revealed "Notice to Patients This hospital is required by federal law to provide any presenting patient with a medical screening examination to determine whether an emergency medical condition exists and to provide necessary stabilizing care within its capabilities for emergency medical conditions without regard to the patient's means or ability to pay. ... Transfer is accepted by: Name of Receiving Physician [space] on Date/Time [space] ... Records Sent: [block for checkmark] Complete Chart [block for checkmark] EKG [block for checkmark] Labs [block for checkmark] X-rays [block for checkmark] Physician's Orders [block for checkmark] Nurses' Notes [block for checkmark] Progress Notes ..." Review of MR1 on January 24, 2019, at approximately 10:30 AM revealed the patient of MR1 arrived to the Emergency Department (ED) via ambulance at 1018 on January 18, 2019, following a period of unresponsiveness. Cardiopulmonary resuscitation was given by the ambulance staff. A nursing note written at 1035 stated [name] helicopter was en route to the hospital. An intravenous line was started, and blood work was drawn. The physician progress note revealed the patient was intubated. The physician documented they discussed the benefits, risks and alternative to transfer of the patient to the mother. The patient's condition was critical at the time of transfer. Review of the "Transfer Consent" form revealed no name of accepting physician listed on the form. Interview with EMP1 at approximately 1045 on January 24, 2019, confirmed the above findings in MR1 and confirmed no name of accepting physician was listed on the "Transfer Consent" form. Telephone interview at 1355 on January 24, 2019, with CF1 revealed they took care of the patient of MR1 on January 18, 2019. CF1 stated they did not call the receiving hospital to obtain an accepting physician, because the transfer had already been arranged by the Emergency Medical Services prior to the patient arriving to the hospital. Review of MR2 at approximately 1100 on January 24, 2019, revealed this patient was seen in the ED on January 8, 2019. The patient required transfer to a higher level of care. Review of the "Transfer Consent" form revealed no documentation of what medical records were sent with the patient to the receiving hospital. Review of MR4 at approximately 1130 on January 24, 2019, revealed this patient was seen in the ED on January 10, 2019. The patient required transfer to a higher level of care. Review of the "Transfer Consent" form revealed no documentation of what medical records were sent with the patient to the receiving hospital. Interview with EMP1 at approximately 1045 on January 24, 2019, confirmed the above findings in MR2 and MR4. No documentation of what medical records were sent with these patients to the receiving hospital was present in these medical records.