Part A is the Drug Report, Part B the Device Report and Part C the Ventilator Settings.
Who completes it: the sending facilities medical provider that is in charge of patient care.
Signed and attached: Part A, Part B and Part C shall be completed as indicated, signed by the sending facility and attached to the EMS ePCR once transport is complete.
EMS service: must retain a copy of this form for their records.
Part C: if a ventilator is used during interfacility transport, the ventilator settings information must be reported to the receiving Paramedic.
Filing: the form is filed with the ePCR (electronic patient care report) and uploaded into the state database.
| Question | Answer |
|---|---|
| Form Name | 3485-ENG-DPH |
| Form Length | 4 pages |
| Fillable? | Yes |
| Fillable fields | 109 |
| Avg. time to fill out | 19 min |
| Edition | 05/2025 |
| Issuing agency | South Carolina Department of Public Health |
| Who completes it | The sending facilities medical provider that is in charge of patient care |
| Filed with | The ePCR (electronic patient care report), then uploaded into the state database |
| Other names | 3485-ENG-DPH, 3485 ENG DPH, DPH 3485, Interfacility Transport Form, Bureau of EMS and Trauma Interfacility Transport Form |
| Official source | 3485-ENG-DPH (Rev 05/2025), South Carolina Department of Public Health |
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