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Nova Fairfax Hospital Department of Medicine
Suggested Discharge Summary Format
(Modified from Tulsa Department of Internal Medicine)
Patient Name:
Admission Date:
Discharge Date:
Attending Physician:
Dictating
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How to fill out discharge summary template
How to fill out a discharge summary template?
01
Start by gathering all the necessary information, such as the patient's name, date of admission, and date of discharge.
02
Begin the discharge summary by providing a brief overview of the patient's condition upon admission and any significant events or treatments that occurred during their hospital stay.
03
Include details about the patient's current medical status and any ongoing care or follow-up appointments prescribed by their healthcare provider.
04
Summarize the patient's diagnosis and treatment plan, highlighting any medications prescribed or changes made.
05
Document any relevant test results, such as laboratory reports or imaging studies, and include them in the discharge summary.
06
Provide clear instructions for the patient and their caregivers regarding any necessary at-home care, medication administration, or lifestyle modifications.
07
End the discharge summary by including the names and contact information of the healthcare professionals involved in the patient's care, as well as any resources or support services available to them.
Who needs a discharge summary template?
01
Medical professionals: Discharge summary templates are essential for physicians, nurses, and other healthcare providers to effectively communicate the patient's medical history, treatment plan, and follow-up care to other members of the healthcare team.
02
Patients and caregivers: A discharge summary template serves as a valuable reference for patients and their caregivers, providing them with a detailed summary of their medical condition, treatment, and instructions for aftercare.
03
Healthcare facilities: By utilizing discharge summary templates, healthcare facilities can ensure that accurate and standardized information is provided to patients, medical professionals, and insurance providers, streamlining the discharge process and promoting continuity of care.
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What is discharge summary template?
Discharge summary template is a document that outlines a patient's medical history, treatment during hospitalization, and follow-up care recommendations.
Who is required to file discharge summary template?
Healthcare providers, specifically the discharging physician or healthcare facility, are required to file the discharge summary template.
How to fill out discharge summary template?
To fill out the discharge summary template, healthcare providers must include details such as the reason for hospitalization, treatment provided, medications prescribed, and follow-up instructions.
What is the purpose of discharge summary template?
The purpose of the discharge summary template is to provide a comprehensive overview of a patient's stay in the hospital and coordinate their care after discharge.
What information must be reported on discharge summary template?
The discharge summary template must include information on the patient's medical history, reason for hospitalization, treatment received, medications prescribed, and follow-up care recommendations.
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