• COVID-19 Discharge Form

    To be completed for every patient with confirmed COVID-19 at discharge, transfer or death.
  • Type
  • Date of Discharge/Transfer/Death
     - -
    2 digit month, 2 digit day, 4 digit year
  • At any time during hospitalization did the patient experience any of the following complications?
  • Was there other pathogens tested for during admission?
  • At any time during hospitalisation, did the patient receive/undergo any of the following treatments?
  • While hospitalised or at discharge, were any of the following medication administered?

  • Patient’s Outcome

  • Ability to self-care at discharge versus before illness

  • Post-discharge treatment:

  • Oxygen therapy?
  • Dialysis/renal treatment?
  • Other intervention or procedure?
  • Should be Empty:
Select theme: