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Discharge Summary Template 1


Discharge Summary Template 1
Discharge Summary Template 1
St Elsewhere and Somewhere Hospitals NHS Trust
Page 1 of 2
Discharge Summary USE BLACK INK ONLY
Patient Details
Admission and GP Details
Surname
Forename M / F/ ……………
Date of Birth
NHS/ Hosp No.
Address
Tel No.
Discharging Consultant
Discharging Speciality/ Department
Method of Admission
Date of Discharge
Date of Discharge
G.P. Details
Diagnosis at Discharge
Operations and Procedures
Reason for Admission and Presenting Complaint(s)
Clinical Narrative
Relevant Investigations and Results
Discharge Destination
Relevant legal Information (e.g. was an independent 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 Admission At Discharge
Physical
Cognitive
Other
Advice, recommendations and future plans (including results awaited and outstanding investigations)
G.P. Actions (Date)
Strategies for potential problems
Discharge Summary Template 1
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