Government of Ontario: Ministry of Health
Memorandum of Transfer – NCR Patient
To: Officer-in-charge of (name of psychiatric facility)
This is to advise you that patient (name of patient)
under the authority of
dated
has been transferred/placed under your authority subject to the wording of the above warrant.
It is therefore understood that you will assume full responsibility for the said patient as of (date)
Sending
(Hospital Administrator) Sending
date
Receiving
(Hospital Administrator) Receiving
name of facility
address
date
NB. Please return one signed form and retain one copy for your record.
1470–41 (92/11)*
7530–4768