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Discharge Plan Format

The discharge plan outlines instructions for a patient being released from the hospital, including their medications with dosages and frequencies, exercises, therapy, health teachings, follow-up visits, dietary plan, and spiritual care referrals. The patient's name, age, gender, room number, date, time, chief complaints, diagnosis, and attending physician are provided at the top. Specific instructions are given for each area to ensure the patient continues their recovery at home.

Uploaded by

Suzette Rae Tate
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
289 views

Discharge Plan Format

The discharge plan outlines instructions for a patient being released from the hospital, including their medications with dosages and frequencies, exercises, therapy, health teachings, follow-up visits, dietary plan, and spiritual care referrals. The patient's name, age, gender, room number, date, time, chief complaints, diagnosis, and attending physician are provided at the top. Specific instructions are given for each area to ensure the patient continues their recovery at home.

Uploaded by

Suzette Rae Tate
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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D I S C H A R G E

P L A N

Name of Patient: _______________Age: ____Gender: _____Room Number: ________ Date:


____________
Time: ________________
Chief Complaints: ________________________________
Diagnosis/Impression:_______________________________________
Attending Physician: ________________________________________
MEDICATIONS
Medications
List all drugs for the patient to
be taken at home.

Dosage/Frequency
Give the full prescription
Example:

Nursing Instructions
Include patient teaching ( to
take before or after meal,
activities to avoid, signs to
watch, etc.

One tablet three times a day


Or
1 tablet 3 X a day

EXERCISE (Included step by step procedure)

THERAPY

HEALTH TEACHINGS

OPD VISITS/REFERRALS

DIET (Foods to encourage and any food restrictions, 3-day sample menu plan)

SPIRITUAL CARE (based on patients religious practices)


Ref.:___________________________________________________

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