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St Elsewhere and Somewhere Hospitals NHS Trust
Page 1 of 2
Discharge SummaryUSE BLACK INK ONLY
Admission and GP Details
Forename M / F/ ……………
Date of Birth
NHS/ Hosp No.
Discharging Speciality/ Department
Method of Admission
Date of Discharge
Diagnosis at Discharge
Operations and Procedures
Reason for Admission and Presenting Complaint(s)
Relevant Investigationsand Results
Relevant legal Information (e.g. was anindependent Mental Capacity Act Advocate required)
Information given to patient and/or authorised representative(including e.g. see GP in 2 weeks)
Physical Ability & Cognitive Function :On AdmissionAtDischarge
Advice, recommendations and future plans (includingresults awaitedand outstanding investigations)
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