Grady Burn Center
3rd Floor, West Tower - B Wing
80 Jesse Hill Jr. Drive, SE
Atlanta, GA 30303
Phone: (404) 616-BURN (2876)
www.gradyburn.org
Grady Burn Center Leadership
Walter L. Ingram, M.D.
Medical Director
Gary A. Vercruysse, M.D.
Co-Medical Director
Grady Transfer Center
Phone: 1-866-GRADY-TX
Fax: 404-616-9208
Burn Transfer Information Form
Date
Time
Time of Injury
Referring Hospital
Phone Number
Estimated TBSA%
Referring Physician
Patient Name
Sex M / F
Age
Cause of Burn
Body Surface Area in Percent
Areas Burned
Asscociated Injuries
Current Medications
Past Medical History
Smoker
Alcohol
Yes / No
Tetanus Status
given / UTD / needs
Patient Weight
lbs
kgs
Inhalation Injury Yes / No
Alert and Oriented Yes / No
Intubated Yes / No
Circumferential Burn Yes / No
Pulses Present
Yes / No
IV Lactated Ringers Rate
Location
Escharotomies
Yes / No
Total Infused
2-4 cc x %TBSA Burn x weight (kg)
half of total given in first 8 hours
Foley Yes / No
Total Output
Vitals
Pulse
BP
Yes / No
Resps.
Mode of Transportation ambulance / helicopter / private vehicle / fixed wing
Grady can assist with arranging transportation
Estimated time of arrival at Grady
Signature of Recorder
Look on back side of transfer form for directions to Grady Burn Center
123353 Grady OB Transfer Referal Form.indd 1
10/26/10 12:04 PM
Directions:
From the North:
Take Southbound I-75/85 to downtown Atlanta. Exit at 248D (Jesse Hill Jr. Drive).
Cross over Edgewood Avenue. Take a left onto Coca Cola Place, right onto Pratt
Street, right onto Decatur Street, then right onto Jesse Hill Jr. Drive.
From the South:
Take Northbound I-75/85 toward downtown Atlanta. You will pass Grady Memorial
Hospital on the left. Take Exit 248B (Edgewood Avenue) and turn left at the end of
the exit ramp. Go to the second light and turn left onto Jesse Hill Jr. Drive. Go one
block and turn left onto Coca Cola Place. Go one block to the stop sign and make
a right onto Pratt Street. Drive past the back of the hospital and turn right onto
Decatur Street. Stay in the right lane and turn right at Jesse Hill Jr. Drive.
From the West:
Take I-20 east toward downtown Atlanta to I-75/85 North.
Then follow the "From the South" directions.
From the East:
Take I-20 west toward downtown Atlanta to I-75/85 North.
Then follow the "From the South" directions.
From Atlanta Hartsfield-Jackson International Airport:
Take Northbound I-75/85 toward downtown Atlanta. You will pass Grady Memorial
Hospital on the left. Take Exit 248B (Edgewood Avenue) and turn left at the end of
the exit ramp. Go to the second light and turn left onto Jesse Hill Jr. Drive. Go one
block and turn left onto Coca Cola Place. Go one block to the stop sign and make
a right onto Pratt Street. Drive past the back of the hospital and turn right onto
Decatur Street. Stay in the right lane and turn right at Jesse Hill Jr. Drive.
Parking
Parking (Butler Parking Deck) entrance is off Jesse Hill Jr. Drive. The parking deck is
attached to McDonalds. This is the only parking available in the area and is reserved
exclusively for Grady Health System patients and visitors.
123353 Grady OB Transfer Referal Form.indd 2
10/26/10 12:04 PM