About downloading the hospital transfer request form
Last updated: August 26, 2024
On October 1, 2017, the Tokyo Metropolitan Government revised a portion of its "Implementation Standards for Transporting and Accepting Injured and Sick Persons."
When transferring to another hospital, please fill out the necessary information on the transfer request form and submit it to the arriving ambulance.
Additionally, as of October 1, 2019, some of the contents have changed, so we have changed to the new format.
Download form
PDF format
It is in PDF file format, so please print it out and use it.
Note : We recommend using plain paper for printing and A4 or B5 print size.
Thermal paper for thermal printers will not be accepted.
Transfer request form (PDF: 341KB)
Word/Excel format
These documents are in Word and Excel file formats, so please print them out and use them.
Note : We recommend using plain paper for printing and A4 or B5 print size.
Thermal paper for thermal printers will not be accepted.
Transfer request form (Word: 52KB)
To open PDF files, you need Adobe Acrobat Reader DC (formerly Adobe Reader).
If you don't have it, you can download it for free from Adobe.
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Inquiries regarding this page
Inagi City Fire Department Headquarters Police Department
2111 Higashinagumanuma, Inagi City, Tokyo (Inagi Fire Station)
Phone: 042-377-7119 Fax: 042-377-0119