
Get the free DISCHARGE RECORD
Show details
E. DISCHARGE RECORD (SEE INSTRUCTIONS ON REVERSE) 1. Participant Name/I.D. No.2. PRU No. and/or Site Name3. Date of Discharge4. Discharge Reason Individuals admitted to counseling programs having
We are not affiliated with any brand or entity on this form
Get, Create, Make and Sign discharge record

Edit your discharge record form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.

Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.

Share your form instantly
Email, fax, or share your discharge record form via URL. You can also download, print, or export forms to your preferred cloud storage service.
Editing discharge record online
To use our professional PDF editor, follow these steps:
1
Set up an account. If you are a new user, click Start Free Trial and establish a profile.
2
Upload a file. Select Add New on your Dashboard and upload a file from your device or import it from the cloud, online, or internal mail. Then click Edit.
3
Edit discharge record. Rearrange and rotate pages, insert new and alter existing texts, add new objects, and take advantage of other helpful tools. Click Done to apply changes and return to your Dashboard. Go to the Documents tab to access merging, splitting, locking, or unlocking functions.
4
Save your file. Select it from your records list. Then, click the right toolbar and select one of the various exporting options: save in numerous formats, download as PDF, email, or cloud.
Uncompromising security for your PDF editing and eSignature needs
Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
How to fill out discharge record

How to fill out discharge record
01
Start by gathering all the necessary information such as patient's name, date of admission, and date of discharge.
02
Ensure you have access to the discharge record form.
03
Fill in the patient's personal details accurately, including their full name, date of birth, and contact information.
04
Record the details of the hospital or healthcare facility where the patient was admitted.
05
Specify the date and time of admission and discharge.
06
Provide a brief summary of the patient's condition and reason for admission.
07
Include details of any procedures or treatments performed during the hospital stay.
08
Document the medications prescribed to the patient during their stay.
09
Note any specific instructions or recommendations given to the patient upon discharge.
10
Ensure all sections of the discharge record form are accurately completed and signed by the relevant healthcare professionals involved.
11
Make a copy of the discharge record for the patient's personal records, if required.
12
Submit the original completed discharge record to the appropriate department or personnel according to the hospital's protocol.
Who needs discharge record?
01
Patients who have been admitted to a hospital or healthcare facility and have now been discharged.
02
Medical staff and healthcare professionals who require a comprehensive record of the patient's hospital stay and treatment.
03
Insurance companies or government agencies that may need to verify the patient's medical history and treatment.
04
Legal entities in case of any legal disputes or claims related to the patient's hospital stay.
05
Researchers or academic institutions studying medical trends and patterns.
Fill
form
: Try Risk Free
For pdfFiller’s FAQs
Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.
How can I modify discharge record without leaving Google Drive?
Simplify your document workflows and create fillable forms right in Google Drive by integrating pdfFiller with Google Docs. The integration will allow you to create, modify, and eSign documents, including discharge record, without leaving Google Drive. Add pdfFiller’s functionalities to Google Drive and manage your paperwork more efficiently on any internet-connected device.
How do I fill out discharge record using my mobile device?
You can quickly make and fill out legal forms with the help of the pdfFiller app on your phone. Complete and sign discharge record and other documents on your mobile device using the application. If you want to learn more about how the PDF editor works, go to pdfFiller.com.
Can I edit discharge record on an iOS device?
No, you can't. With the pdfFiller app for iOS, you can edit, share, and sign discharge record right away. At the Apple Store, you can buy and install it in a matter of seconds. The app is free, but you will need to set up an account if you want to buy a subscription or start a free trial.
What is discharge record?
Discharge record is a document that provides details of a patient's release from a healthcare facility.
Who is required to file discharge record?
Healthcare providers and facilities are required to file discharge records.
How to fill out discharge record?
Discharge records are typically filled out by healthcare professionals and include information such as the patient's diagnosis, treatment received, and follow-up care instructions.
What is the purpose of discharge record?
The purpose of a discharge record is to ensure that the patient's healthcare information is accurately documented and shared among healthcare providers.
What information must be reported on discharge record?
Information such as the patient's name, date of birth, medical history, diagnosis, treatment plan, medications prescribed, and follow-up care instructions must be reported on a discharge record.
Fill out your discharge record online with pdfFiller!
pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Discharge Record is not the form you're looking for?Search for another form here.
Relevant keywords
Related Forms
If you believe that this page should be taken down, please follow our DMCA take down process
here
.
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.