Facilities/Agencies � Please contact our Dispatch Communications Center as usual at (903) 856 6931 at the time patient transfer is actually ready to be performed. This form allows Camp County EMS to preposition the most appropriate unit in the most efficient locations in order to provide the best possible service to our clients, but does not replace contacting Dispatch for transfers.�

Do NOT use this form to request a pre-hospital "911" response.
Contact 911 directly for emergency ambulance responses

Fields with an * are required.
*Originating Facility or Home Address:
(Please specify Agency and City if Hospice or other non-hospital entity)
*Originating Room Number or Department:
(ie: "2512B," "ER" or "CVICU")
*Destination Facility or Address:
*Nature of Transfer:
(ie: "Routine Return" "Cardiac," "Obstetrical," etc)
*Estimated Time Patient will be ready for transport:
*Point of Contact Name:
*Point of Contact Telephone:
Any additional information which may be needed:
(ie: “Patient on vent”, “Nurse will accompany”, any medications patient will receive enroute, etc)

Enter Security Code: