Objective To design a referral form of transitional care for elderly patients discharged from tertiary hospitals, and to eva-luate its application effect.Methods Based on references and focus group discussion, a referral form of transitional care for elderly patients was designed and embedded in the hospital′s electronic medical record information system.Ward nurses used the referral form to refer patients that needing transitional care, then the full-time nurses in the transitional care department received the referral form and went to the wards to provide discharge planning services, and provided home care services after discharge.Results From 2021-2022, the referral form of transitional care for elderly patients was applied in 21 departments of the hospital.A total of 386 elderly patients were referred by using the form, among whom 219 patients were over 80 years old (56.7%), and 267 patients were referred from 9 departments of the internal medicine system (69.2%).All 386 patients were provided with home care services 597 times within 1 month after discharge, and the rate of unplanned readmission within 30 days of discharge was 5.2%.Conclusion Design and application of the referral form of transitional care for elderly patients is conducive to promoting the referral and improving the cooperation and coordination between staff in different departments, so as to meet the needs of discharged elderly patients for transitional care services and reduce the rate of unplanned readmission after discharge.