Inagi City

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.

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.

Inquiries regarding this page

Inagi City Fire Department Headquarters Police Department Phone: 042-377-7119