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    Hospital Discharge Template

    by articleslounge Cloned 55
    It is a good practice to always crosscheck and make sure that everything is in order before discharging a patient. In order to ensure this, hospital management usually has a form which they fill and check in before discharging a patient. In our world today where people are using less of paper, this hospital discharge template is one PDF document you can use to save patient discharge information.

    The essence is that you can easily check the information saved in the PDF document to ensure a patient can be discharged. The hospital discharge letter template here can be modified to suit your taste.

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    Hospital Discharge Template
    100%
    Hospital Discharge Form
    Saturday, March 9, 2019

    Basic Information

    Complete this form for all hospital discharges. Refer to Hospital Discharge Summary Form Instructions for information on how to complete this form.

    Patient's Name
    Maryann Andreuzzi
    Patient's I.D. #
    Curabitu
    Phone Number:
    (72) 3908539
    Facility Name
    Curabitur in libero
    Attending Physician
    Cyril Blackwood
    Date Services should end
    Thursday, May 18, 2006
    Elements that need to be put in place prior to discharge (verify that the following information is documented in the record, if applicable)
    Physician note reflecting readiness for discharge
    Discharge plan discussed with member/family
    Discharge plan discussed with attending provider
    Description of discharge plan in place
    Therapy notes (if applicable)
    Bill paid

    Medical Information

    Fill in detailed and specific information about the patient’s current medical condition and the reasons why services are no longer reasonable or necessary for this patient or are no longer covered according to Medicare or Medicare managed care coverage guidelines. (Use full sentences, plain language and no abbreviations)

    a. You were admitted to (see facility above) on the following date
    Tuesday, July 26, 1983
    b. At admission you presented with the following symptoms
    Proin interdum mauris non ligula pellentesque ultrices. Phasellus id sapien in sapien iaculis congue. Vivamus metus arcu, adipiscing molestie, hendrerit

    Medical Information Continues...

    c. You were diagnosed with
    Proin interdum mauris non ligula pellentesque ultrices. Phasellus id sapien in sapien iaculis congue. Vivamus metus arcu, adipiscing molestie, hendrerit at, vulputate vitae, nisl.
    d. You were treated with
    Proin interdum mauris non ligula pellentesque ultrices. Phasellus id sapien in sapien iaculis congue. Vivamus metus arcu, adipiscing molestie, hendrerit at, vulputate vitae, nisl.
    e. Your tests were (include results)
    Nam congue, risus semper porta volutpat, quam pede lobortis ligula, sit amet eleifend pede libero quis orci. Nullam molestie nibh in lectus.

    Medical Information Continues...

    f. You were evaluated by
    Proin interdum mauris non ligula pellentesque ultrices. Phasellus id sapien in sapien iaculis congue. Vivamus metus arcu, adipiscing molestie, hendrerit at, vulputate vitae, nisl.
    g. You are now (list current treatment plan and/or state the medical issue is resolved)
    Proin interdum mauris non ligula pellentesque ultrices. Phasellus id sapien in sapien iaculis congue. Vivamus metus arcu, adipiscing molestie, hendrerit at, vulputate vitae, nisl.
    h. Your provider feels that your condition has improved and that the care you need now could safelybe provided in/at
    Cum sociis natoque penatibus et magnis dis parturient montes, nascetur ridiculus mus. Etiam vel augue. Vesti
    i. Your discharge plan and follow-up care includes
    Nam congue, risus semper porta volutpat, quam pede lobortis ligula, sit amet eleifend pede libero quis orci. Nullam molestie nibh in lectus.

    Other Information

    Printed name of person completing the form
    Delia Clowney
    Phone Number
    (94) 3961603
    Signature of person completing the form
    Proin inter
    Hospital Discharge Template

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    Disclaimer

    Noth­ing on this site is intended to estab­lish a physician-patient rela­tion­ship, to replace the ser­vices of a trained physi­cian or health care pro­fes­sional, or oth­er­wise to be a sub­sti­tute for pro­fes­sional med­ical advice, diag­no­sis, or treatment.