Friday, February 6, 2015

Discharge Summary Template

Date of Admission: 
Date of Discharge: 
Service: Medicine Team H
Attending: Mark Richman
Resident: Patrick Poquiz
Intern: Brian Truong

Discharge Diagnoses (no abbreviations; list all conditions from past medical history and that developed during hospitalization): 

Procedures: 

Imaging


History of present illness: 

Hospital Course: 

Disposition: Discharge to home

Code Status: Full

Discharge Condition: Good

Pending Studies: 

Discharge Activity: Ambulating

Discharge Diet: 

Discharge Medications: 

Follow-up Instructions: Follow-up with PCP in 2-3 days. 

[ ] Central line, PICC line, or dialysis catheter present and indicated 

Discharge plan discussed with attending who concurs with plan.