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Six Core Elements
Transition Policy
Tracking & Monitoring
Transition Readiness
Transition Planning
of Care
Transfer Completion
Measuring Transition

Transfer of Care

  • Confirm date of first adult provider appointment.
  • Transfer young adult when his/her condition is stable.
  • Complete transfer package, including final transition readiness assessment, plan of care with transition goals and pending actions, medical summary and emergency care plan, and, if needed, legal documents, condition fact sheet, and additional provider records.
  • Prepare letter with transfer package, send to adult practice, and confirm adult practice's receipt of transfer package.
  • Confirm with adult provider the pediatric provider's responsibility for care until young adult is seen in adult setting.


Creating a transfer of care checklist for the practice, preparing a transfer package for youth leaving the practice, and communicating with the new adult provider is the fifth element in these health care transition quality recommendations. The transfer package contains a transfer letter along with the final transition readiness assessment, transition goals and actions accomplished or yet to be achieved, a medical summary and emergency care plan, and, if needed, legal documents. If the youth's condition is one that adult providers do not routinely encounter, adding a condition fact sheet to the transfer package is helpful. A telephone conversation with the adult provider may be warranted for transitioning youth with more complex health and psychosocial needs. Transfer to an adult provider is recommended before the age of 22.

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Got Transition™ is a program of National Alliance Logo The National Alliance to Advance Adolescent Health supported by U39MC25729 HRSA/MCHB