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Discharge Summary: Form No.: Hospital No.: Case No.: Room No.

This discharge summary provides key details about a patient's hospitalization including their name, age, sex, admitting and discharge dates and times, admitting diagnosis, final diagnosis, chief complaints, brief clinical history, pertinent physical exam findings, laboratory and diagnostic test results, course of treatment in the ward including medications, and disposition instructions including home medications, special instructions, and follow-up plans. The attending physician signs off with their printed name, role, and license number.

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Aina Haravata
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2K views1 page

Discharge Summary: Form No.: Hospital No.: Case No.: Room No.

This discharge summary provides key details about a patient's hospitalization including their name, age, sex, admitting and discharge dates and times, admitting diagnosis, final diagnosis, chief complaints, brief clinical history, pertinent physical exam findings, laboratory and diagnostic test results, course of treatment in the ward including medications, and disposition instructions including home medications, special instructions, and follow-up plans. The attending physician signs off with their printed name, role, and license number.

Uploaded by

Aina Haravata
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Form No.

Hospital No.:

Case No.:

Room No.:

DISCHARGE SUMMARY
Name: ______________________________________________ AGE: ________ SEX: ________ STATUS: ___________
Address: __________________________________________________________________________________________
Attending Physician: __________________________________________________________________________________
Admitting Date: __________________ Time: _____________ Discharge Date: __________________Time: ____________
Admitting Diagnosis: __________________________________________________________________________________
___________________________________________________________________________________________________
Final Diagnosis: ______________________________________________________________________________________
____________________________________________________________________________________________________
Chief Complaints: ____________________________________________________________________________________
Brief Clinical History and Pertinent Physical Examination: ___________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Laboratory Findings: (Including ECG, X-RAY and other Diagnostic Procedures)
___________________________________________________________________________________________________
Course in the Ward: (Include the Medication)
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Disposition: (Indicate Home Medication and special instruction and follow-up)
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

____________________________, MD
Signature over Printed Name
Resident on Duty
License No.:

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