It is assumed that an initiative effort was undertaken when the nursing home exhausted all reasonable means and took all necessary and proportionate steps to reach an agreement with a hospital close to the facility, which is close enough to the facility to ensure the safety and order of the transfer of residents. The facility (with the exception of a state-based care facility located on an Indian reserve) must have, pursuant to section 1861 (l) of the Act, a written transfer agreement with one or more licensed hospitals to participate in the Medicare and Medicaid programs and which reasonably guarantees that residents are transferred from the facility to the hospital. , and ensure timely admission to the hospital if the transfer is medically appropriate, as determined by the attending physician or, in an emergency situation, by another physician, in accordance with settlement policy and in accordance with national law; and medical and other information for the maintenance and treatment of residents and, if deemed appropriate, to determine whether these residents can receive appropriate services or services in a less restrictive environment than the institution or hospital, are exchanged between providers, including, but not limited to, the information required under paragraph 483.15 c) (2) iii). (1) By a participating hospital with which the SNF actually has a transfer contract in accordance with paragraph (1) of this section; Or, to quote the poor practice of F843, the surveyor`s examination will generally show that the institution has not performed any of the following tasks: also refer to the registration, transmission and dismissal fees in the 483.15 list. The information contained in the delegation agreement should support the requirements set out in 483.15 (c), at F622 and the mechanism`s efforts to ensure safe and orderly transfers. In addition, the agreement should contain the information covered in paragraph 483.15 (2) (iii) and take into account other information that may be necessary to ensure the safe and orderly transfer of the resident as well as for the care and treatment of the resident at the place of reception. (1) A participating hospital with which the SNF has, in fact, reached an agreement. 483.70, point j), in this chapter, on patient transmission and the exchange of medical records; or an institution must demonstrate its good intentions in order to obtain a transfer contract with a hospital.