Fillable Form Hospital Discharge Paper

What is a Hospital Discharge Paper?

A Discharge Paper is a sample form only for patients who are ready to leave the clinic or hospital.

Through this form, there will be a smooth, easy process for both patients and staff.

Before discharging patients from the hospital, certain information must be on file. For this purpose, a discharge paper may help to gather patient information, a follow-up plan, and any other data needed for a successful discharge.

Discharge papers must be kept by hospitals or clinic safe and secure as it contains information about the patient.

How to fill out a Hospital Discharge Paper?

This discharge form is simple and straightforward. It contains six (6) parts: Patient Details, Primary Healthcare Professional Details, Admission and Discharge Details, Diagnosis and Procedures, Medication Details, and Prepared by section.

Patient Details
Provide the required details of the patient.

First Name
Enter the first name of the patient.

Last Name
Enter the last name of the patient.

Middle Initial
Enter the middle initial of the patient.

Date of Birth
Enter the birth date of the patient.

Age
Enter the age of the patient.

Sex
Enter the sex of the patient.

Address
Enter the address of the patient.

City
Enter the city where the patient resides.

State
Enter the state where the patient resides.

Zip
Enter the zip code where the patient resides.

Primary Healthcare Professional Details
Provide the required primary healthcare professional details.

First Name
Enter the first name of the primary healthcare professional concerned.

Last Name
Enter the last name of the primary healthcare professional concerned.

Middle Initial
Enter the first name of the primary healthcare professional concerned.

Hospital/Clinic Name
Provide the name of the hospital or clinic.

Address
Enter the address of the hospital or clinic.

City
Enter the city where the hospital or clinic is located.

State
Enter the state where the hospital or clinic is located.

Zip
Enter the zip code of where the hospital or clinic is located.

Admission and Discharge Details
Provide the required admission and discharge details.

Date of Admission
Enter the date the patient was admitted.

Source of Referal
Enter the referral source.

Method of Admission
Provide the method of admission of the patient.

Date of Discharge
Enter the date the patient was discharged.

Discharge Reason
Select the reason for discharge of patient (Treated, Transferred, Discharged Against Advice, or Patient Died). If the reason for discharge was the death of the patient, select “Patient Died” and enter the date of death on the space provided.

Diagnosis & Procedures
Provide the information on the diagnosis and procedures done to the patient on the respective spaces provided. Include the principal diagnosis in a brief manner. This will establish the main reason that is responsible for the patient’s visit to the hospital. Also, write the additional diagnosis which is the one that affects the patient’s management.

All the diagnostic and therapeutic procedures that are taken during the time of admission and discharge should be entered as well.

Medication Details
Enter all details of the medication given to the patient on discharge.

Prepared by
Enter the details of the healthcare staff that filled out the information.

Signature
Provide your signature.

Date
Provide the date the form was filled out and signed.

Name
Enter your name.

Job Title
Provide your job title.

Frequently Asked Questions About a Hospital Discharge Paper

Do hospitals give discharge papers?

Yes, hospitals give discharge papers. Discharge papers are given to you after your routine check-up, surgery, or even minor sickness, as they may be used for many purposes.

Discharge papers are important especially if you're planning to avail of health insurance services because they can be used as proof that you have undergone medical treatment only recently. This only means that you still have a high chance of getting approved by the insurer since they will assume that you have a good health condition. They can also be used as proof of medical expenses on time since most health insurances offer claims within 30 to 60 days from the date of service unless the delay is valid like if you're waiting for clearance from your doctor before filing a claim. That's why discharge papers are very important especially if you were advised by the doctor to undergo some laboratory tests.

Discharge papers contain your health condition, allergies, the medicines you're taking, and your doctor's advice for better health maintenance. It will also reflect clearly what are your pre-existing conditions.

Please take note that discharge papers will only be given to you by the attending physician of the patient or someone authorized by the doctor. You should also know that hospitals will not be held liable for any lost discharge papers and should be informed immediately if you lose them.

How do I write a letter of discharge from a hospital?

A letter of discharge from a hospital should include all the following information:

• The patient's details:
  • Name, age, and sex
  • The address and contact information details, such as phone number and email
  • Insurance policy or other health coverage information
• The information of the attending physician
  • Name and credentials (MD)
  • Medical license number, if applicable
  • Contact information, including phone number and email address — This may not be included
• Admission and discharge details
  • Date the patient checked in to the hospital
  • Date of admittance, if different from the date of check-in
  • Reason for admittance or what brought about the need for hospitalization
  • Expected length of stay at the institution — This may not be included.
  • Date and time of discharge
  • Date and time that the attending physician discharged the patient
• Diagnosis, procedures, and medication details
  • Required medical treatment, such as medications or required follow-up procedures — This might include the date of administration.
  • Diagnosis, if there was one — Not all discharge letters will have diagnoses, but it is important to include one if given by the physician.
  • Procedure or procedures performed on the patient — This may include X-rays, CT scans, surgery interventions, and other procedures. The recovery time for such procedures is usually not included.
• The signature of the attending physician — The signature of the attending physician needs to be included in all discharge letters. If there are other health care providers who attended to the patient, their signatures may need to be part of the discharge letter as well.

What should a discharge plan include?

A hospital discharge plan is a crucial document that serves as the grounds for the patient's release to return home. It documents various details related to the medical history of the patient, including diagnoses and medications, testing results, treatment plans, and recommendations. Some of the important information a hospital discharge plan should include are:

• Patient’s name and full address
• Date of admission to hospital
• Name of treating physician.
• Diagnosis or reasons for hospitalization — Including investigations that were done and their results, as well as the date the report was read. The diagnosis must also include a brief description of symptoms and signs along with a treatment plan.
• Information about other physicians consulted
• A summary of the results of tests, procedures, and consultations related to diagnosis — Including an explanation of why they were ordered, if not done by the treating physician.
• The patient's discharge status: stable or unstable — May also include any follow-up appointments that need to be made.
• The patient's support system — Including next of kin and emergency contact information.
• Any allergies or other medical conditions
• Scheduled medications — Including dosage
• Details on any other treatments that should be continued after discharge — Such as physical therapy, occupational therapy, or pain management program. It should also include instructions pertaining to any follow-up appointments that need to be made.
• Any other special directions, such as:
  • Patient teaching and discharge education
  • Instructions for the patient's home situation, such as assistance with housekeeping or cooking
  • Dietary restrictions and fluid restrictions
  • Impaired vision, hearing, or both
• The patient's hospital room number and location in the hospital
• A discharge summary listing all medications that were prescribed — Including doses to be taken at home by the patient or caregivers. It should also include any over-the-counter medications, herbal supplements, vitamins, and medications., along with their doses and how often they need to be taken. It should have instructions on how to manage recurrent pain or chronic medical conditions at home should also be included in the discharge summary.
• The date the plan was written and reviewed — This needs to be done by the treating physician.
• The name of the person who wrote it and the name of the person reviewing it — They are usually a nurse and another treating physician.
• The date of discharge and mode of transportation — If the patient is not driving.
• The signature of the patient — or guardian for a child — and that of a physician.

What is included in a hospital discharge summary?

A hospital discharge summary must have the following information:

• Name or identification code of the patient
• Date and time of admission and discharge — In 24-hour clock.
• Document number at the hospital and space for insertion of future document numbers — If available
• Name and signature of the person discharging the patient
• The signature or initials of admitting personnel
• The time that patient was admitted to the hospital — If not on the admission form.
• The time that patient was discharged from the hospital — If not on discharge form.
• A narrative description of the course of the illness — Any symptoms, diagnosis, and treatment prescribed and given by an attending physician.
• The signature or initials of the person preparing the document — These are required if that person is other than an attending physician or registered nurse.

Do you always get a discharge letter from a hospital?

In general, when you get discharged from a hospital, you also get a hospital discharge paper. That's to specify what kind of diseases you had and how much treatment was done. The document details your diagnosis and the treatment course. When you get hospitalized, usually they make a copy of this for your and their records.

If you were not given a hospital discharge paper, you should ask for it because doctors and nurses can use it in the future as a reference. If a certain illness keeps coming back, the hospital will look in their records and see what kind of treatment they did for you before.

How do I write a letter to discharge a patient?

A hospital discharge paper is completed by a doctor when he discharges a patient from his care. The paper should include the following information:

• Patient identification data — Include the patient's name, address, date of birth, and other relevant identification data.
• Physician's name and signature — The physician's name is listed above his or her printed signature. It is against the law in some states for nurses to sign discharge papers, so unless your state allows this, do not list a nurse's signature here.
• Date of discharge — This section lists the date that the patient was internally and externally discharged from the hospital.
• Diagnosis — This section lists the diagnosis, including any risks or complications that may arise as a result of it. Only list risk factors that are associated with this type of injury or illness. For example, if a patient is hospitalized due to a low platelet count, list the low platelet count as a risk factor. The name of the condition is listed first, followed by any tests or procedures that were completed to diagnose the patient.
• Treatment rendered — This section will list all treatments administered with each item written out.
• Patient's response to treatment — This section is where the physician will list the patient's current status, including any changes in her condition.
• Expected date of the return for further care, if any — If the patient is still an inpatient when he is ready to be discharged. This section is completed only if the patient has a date for a follow-up appointment with the physician.
• Description of current condition — In this section, the physician will list the description of the patient's condition as it pertains to new or continuing problems.
• Instructions for future care — This includes medications, diet, and other relevant care for the patient. This section is completed only if the patient will be going home on a new medication or with new dietary restrictions.
• Name and phone number of a contact person — This section includes the name, address, and phone number of anyone who can provide information about the patient's condition.
• Name and phone number of the physician to be contacted in an emergency — This section includes the name, address, and phone number of the patient's primary care physician.
• A section for additional notes or comments, if desired — The physician can write anything else that he feels is pertinent under this section. It may be used for referrals to other hospitals, instructions on how the patient should take his medication, and other relevant instructions.

What does a letter of discharge mean?

A letter of discharge from a hospital means a person has been rehabilitated medically. He is ready to go back to work, can drive his car, and is in good shape. It is a document that verifies a patient no longer requires a physician's care and has been released for full duty.

A hospital discharge letter acts as proof of credibility. This letter is very helpful for patients to verify insurance or government benefits such as disability, pension, or health care coverage. The patient might also need this discharge letter when applying for a job in the future.

What is a patient history?

A patient's history is a medical record that is maintained by healthcare professionals to track an individual's medical history. It provides information on the patient's past and present physical or mental illnesses, their family history of diseases, allergies, and current medications they may be taking. The patient history is often obtained at the first visit with a new physician or other health care provider and may be maintained either in print or electronic form.

Preventative screening may be incorporated into the patient history. Such screenings are often conducted at recommended intervals. For example, vaccinations are generally administered based on age and medical history by health care providers during childhood, so that children receive them at the appropriate age.

A patient's history is recorded during a medical encounter, where questions are asked by the healthcare provider and information on the answers provided by the patient. The data collected may include chief complaints, past medical problems, family history of diseases, a social history of habits, and psychological history. Details are taken about current medications being taken or all drugs taken over the patient's lifetime.

How do you write a patient summary?

A patient summary is a document or record that summarizes the clinical history of a patient into one or two pages. It should contain a problem list, medical history, allergies, current medications, and family history. The purpose of this document is to give healthcare providers concise information about the patient it is attached to without requiring them to access the complete chart every time. Therefore this article summarizes some important parts of a patient summary.

Who is responsible for a discharge summary?

Doctors are responsible for and in charge of a hospital discharge summary. These are the records of patients' treatments and progress with an honest diagnosis of their medical conditions which they can use to seek future treatment.

When should a discharge summary be completed?

A hospital discharge summary must be completed during a patient's stay at a healthcare facility. This form is completed by the patient's doctor, nurse, or other attending professional. The purpose of this form is to document pertinent information provided to the patient, their family, and close friends.

The hospital discharge summary should include information about what medications were given during treatment along with any allergies that were experienced by the patient. The doctor will include any procedures performed during the hospital stay along with their outcomes.

The attending professional should also record any future care that needs to be performed by another healthcare provider or outside of the medical system. This information is important for the patient to follow through on, especially if it pertains to medications, diagnoses, and specific treatments.

A hospital discharge summary is also the time to provide the patient and those close to them with any information that they need about how they can continue their medical treatment as an outpatient. It is not uncommon for a doctor to recommend that a patient follow up with another type of specialist or even an inpatient facility if their condition warrants such steps.

Who writes a hospital discharge letter?

The doctor is the one who writes the hospital discharge letter. It contains the details about the patient's admission date, discharge date, and diagnosis. It also includes the doctor's comments and other relevant medical instructions.

Why is a discharge summary important?

A hospital discharge summary is important because it informs patients and doctors about a person's health status after hospital admission. It serves as a basis for future care and helps to recognize any health conditions that need to be made into a routine checkup. Moreover, the discharge summary is also used by the health insurer. It provides information on tests, treatments, and hospital stays of a patient.

What is a discharge checklist?

A hospital discharge checklist is a document that lists the things a person needs or should do before leaving a hospital. It is used to ensure that people are aware of all the medication, therapies, follow-up appointments, and further actions they need after leaving the hospital. A hospital discharge checklist is not standardized across hospitals or countries. Nevertheless, it is critical that all relevant details are included in the checklist for an effective discharge.

A patient's family or caregiver should participate with care providers to make sure that they understand what type of care and interventions will be needed at home after the hospital stay. The discharge plan may include how often a person should see their doctor, who will do the follow-ups, and what additional treatments they should receive. The discharge plan may also include the name of someone who will be available to help with any medical needs after discharge.

Where to submit a hospital discharge paper?

This form is just a sample and may not be used for official purposes. Hospitals and clinics may use this form as a guide to customizing their own discharge paper form.

What are some important tips about a discharge paper?

• Requiring a discharge paper form allows the doctor to summarize the diagnosis and prescription.
• The discharge form allows you to have a database where you can save your patient information in a centralized database and even split medical records in separate databases according to diagnosis or prescriptions. When you log all your patient data, you’ll easily find old records to help you understand your patient’s condition better.
• Write all the required information in a brief and concise point.
• Everything in the discharge summary is confidential and should not be accessed without the patient’s permission.
• Make sure to record all the diagnoses and procedures accurately on the required field for this will serve as information to give to other healthcare providers in the outpatient settings. Furthermore, it is the hospital staff’s responsibility to provide this information accurately.
• Real discharge papers have an address at the top. In making one for your facility, hospital, or clinic, do not forget to add the address or location of your facility with the state, zip code, city, and other address information.
• For patients, filling out the hospital discharge form does not always mean that you are fully recovered.
• For patients, medicines to be taken at home are mentioned in the form with complete details and the duration of medication.
• Depending on the facility, hospital, or clinic, the discharge form is sometimes different from the physician’s excuse template. Ask the hospital staff regarding this.
• There are other healthcare forms available online that you may use such as the Initial Visit Patient form, Consent form, Doctor’s Appointment form, Patient Feedback form, Client Provider’s Intake form, Patient’s Progress form, Medicine Intake form, and the like.
• For patients, if you need more specialized care after leaving the hospital, you must receive a care plan detailing your health and social care needs. Ask the hospital staff for your care plan which includes details of the treatment and support you'll get when discharged, who will be responsible for providing support and mode of contact, when and how often support is needed, how the support will be monitored, and reviewed, name of the person coordinating the care plan, emergency contact, and information about any charges that will need to be paid.
• If you're being discharged, make sure to coordinate with a relative or friend to collect you if needed or let the staff know if they need to make any arrangements for you.
• For patients, you have the right to discharge yourself from the hospital or clinic at any time during your stay.

Relevant Articles:

• Hospital Discharge
• What Should Be Included in a Hospital Discharge Summary?