Transferring your dialysis care safely

You have every right to change dialysis centers or nephrologists. The goal is simple: move your care the safe, documented way — so there is never a gap in your treatment.

Adapted with permission from renalcarematters.com.

It's your right to transfer

Transferring is completely normal. People move for a new job, to be closer to family, because a center is too far or too costly, because of a referral, or simply because they want care that fits them better. Whatever the reason, the choice is yours to make.

As a dialysis patient in the Philippines, you have the right to choose or change your nephrologist, to choose or change your dialysis facility, to request copies or summaries of your medical records, to get a medical abstract or endorsement, to seek a second opinion, and to receive respectful care that is never pressured or punished. No center can hold your records hostage or force you to stay.

The one rule: never stop abruptly

The danger is not transferring — it is transferring abruptly, without telling your current team or confirming your new center. Hemodialysis is life-sustaining, and skipping it is not like missing a regular check-up.

A single missed session is dangerous. Within about 24 to 72 hours, fluid overload and pulmonary edema (water in the lungs) can build quickly, potassium can rise to dangerous levels (hyperkalemia), and uremic symptoms such as confusion, nausea, or even seizures can appear. This can lead to an emergency hospitalization that is completely avoidable. A safe transfer is planned, documented, and continuous — you keep dialyzing on schedule the whole time.

Why a proper turnover matters

Your dialysis is fine-tuned to you. When you move, the receiving center cannot safely start from a blank page — they need to know how your body responds so they can set the machine correctly from your very first session.

A good endorsement passes along your dialysis prescription (dry weight, dialyzer type, blood-flow and dialysate-flow rates, dialysate bath, heparin or heparin-free protocol, and how often and how long you dialyze), your medical profile (blood-pressure tendencies, how much fluid you tolerate having removed, your erythropoietin and iron doses, current medicines, allergies, and recent hospitalizations), and your infection and access details (hepatitis B and C status, the type and history of your fistula, graft, or catheter, and any access problems). Without these, the new center may guess wrong — and the wrong settings can cause low blood pressure, cramps, or a clotted access.

The PSN endorsement form

In the Philippines, the standard tool for a safe handover is the PSN Hemodialysis Patient's Endorsement Form (HPEF), from the Philippine Society of Nephrology. It is a single document your current center fills out and signs, gathering everything the next center needs in one place.

The form covers your patient information and emergency contact, primary diagnosis and other conditions, infection-control status (HBsAg, Anti-HBs, Anti-HCV, and hepatitis vaccination), vascular access details, your full dialysis prescription, current medications, and any history of complications such as low blood pressure during dialysis, severe cramps, clotting, or arrhythmias. It also lists the attachments to bring along — your last three dialysis treatment sheets and your latest laboratory results. Ask your current center to complete and sign it before you leave.

How to transfer centers: the five steps

A safe center-to-center transfer follows a simple order. Never skip ahead — confirming your new slot before you leave the old one is what keeps you dialyzing without a gap.

1. Choose the receiving center first. Confirm they have an available slot and schedule that matches how often you dialyze, that a nephrologist there will accept you, that they are PhilHealth-accredited, and that they can handle your specific needs (for example a tunneled catheter, a hepatitis B-positive status that requires a dedicated machine, a recently revised fistula, frequent low blood pressure, or heparin-free dialysis).
2. Inform your current center and nephrologist. Tell them your plan and request your medical abstract, your completed and signed PSN endorsement form, your dialysis records and last three treatment sheets, and your latest labs.
3. Prepare your complete transfer documents (see the checklist below) so nothing is missing on your first day.
4. Let the receiving center finish their review. They will check your stability, plan your dialysis settings from your prescription, confirm your machine or station assignment, review your medications, and process your PhilHealth enrollment.
5. Make sure no session is missed. Time the switch so your first session at the new center falls on or before your next scheduled dialysis day.

Do not "disappear" from your current center. Never delay dialysis because of paperwork or logistics. If your transfer day is still being arranged, keep going to your current center on schedule until the new one is ready to take you.

What documents to bring

Gather these before your first session at the new center. Keep both the originals and photocopies together in one folder:

Medical: PSN endorsement form, medical abstract, latest dialysis prescription, last 3 HD treatment sheets, laboratory flow sheet, current medication list, vaccination history, and blood type.
Laboratory results: CBC (complete blood count), BUN (blood urea nitrogen) and creatinine, sodium and potassium, calcium and phosphorus, albumin, and hepatitis profile (HBsAg, Anti-HBs, Anti-HCV).
Access documents: AV fistula operative records if available, catheter insertion history, and any angioplasty or access-intervention history.
Administrative: a valid government-issued ID, Senior Citizen or PWD (person with disability) ID if applicable, your PhilHealth ID and Member Data Record (MDR), and your signed consent for release of records.

Changing your nephrologist — same center

Sometimes you want a different doctor but you are happy with your dialysis center. That is allowed too. Simply inform the center administration that you wish to change physicians, and ask to be assigned to another accredited nephrologist at the same facility. Your dialysis schedule, machine, and records stay where they are — only your attending doctor changes. Do this openly and on the record; do not just stop talking to your current doctor and hope things sort themselves out.

Changing centers — same nephrologist

The reverse also happens: you want to move to a more convenient center but keep the doctor you trust. Before you move, confirm one key thing — is your nephrologist accredited to practice at the receiving center? Many doctors cover more than one facility, but not all. If they are accredited there, the transfer is mostly a matter of moving your dialysis schedule and records while your doctor continues to manage your care. If they are not, you will need either a new accredited nephrologist at that center or a different center where your doctor practices.

PhilHealth, DOH, and the rules that protect you

Dialysis centers in the Philippines are licensed by the Department of Health (DOH) and follow the clinical standards of the Philippine Society of Nephrology (PSN). Medical ethics under the Philippine Medical Association (PMA) also protect your right to choose your own doctor and to have your records released to you.

For coverage, PhilHealth supports outpatient hemodialysis, so continuity of billing matters as much as continuity of care. Confirm that the receiving center is PhilHealth-accredited and bring your MDR so your benefit follows you.

PhilHealth tip: confirm the receiving center's accreditation before your first session there. This avoids billing gaps and duplicate claims, and keeps your coverage uninterrupted through the move.

Red flags: when not to transfer right now

Occasionally the safest choice is to delay the transfer until you are more stable or the arrangements are complete. Hold off if you have any of these medical warning signs: severe shortness of breath, very high potassium confirmed on recent labs, an active infection or sepsis, an active infection at your access site, uncontrolled bleeding, persistent low blood pressure, or a recent hospitalization without a proper discharge summary. Stabilize first, then transfer.

Also postpone if the arrangements are not ready: no confirmed slot at the new center, no nephrologist who has accepted you there, the endorsement form not yet completed, the new center's PhilHealth accreditation not confirmed, or a plan that would leave a gap between sessions. A short delay to get these right is far safer than a rushed move.

Your transfer-readiness checklist

Before you leave your current center, you should be able to tick every box below:

I have confirmed a slot and schedule at the receiving center.
I have confirmed a nephrologist there has accepted me.
I have confirmed the receiving center is PhilHealth-accredited.
I have informed my current nephrologist and the center administration.
I have my completed and signed PSN endorsement form and medical abstract.
I have my last 3 dialysis treatment sheets and latest laboratory results.
I have my current medication list and vascular-access history.
I have my PhilHealth MDR and ID, and a valid government ID.

How St. John Biocare makes it easy

Transferring should never feel like starting over. Bring your latest dialysis records, prescription, and endorsement form, and our team will handle the continuity — reviewing your settings, coordinating your schedule, and processing your PhilHealth enrollment — so there is no gap in your treatment. If you are unsure which documents you have or still need, come in and we will walk you through it, one step at a time.

We welcome transfers. Whether you are moving across town or across the country, we will help you switch safely, without missing a single session.

Transfer to St. John Biocare

Adapted with permission from renalcarematters.com. Medically reviewed by a nephrologist. This guide is educational and not a substitute for consultation.