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    Discharge Plan Format

    Uploaded by

    Christian
    This discharge plan outlines instructions for a patient being discharged from the hospital. It includes the patient's diagnosis, surgery undergone, hospital and physician details. It provides objectives and guidelines for medications, exercises, treatments, health teachings, diet, spiritual needs, observed symptoms to report, and discharge details such as date and time, accompaniment, transportation, and condition. The instructions were explained and validated by the patient, relative and clinical instructor.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd

    Discharge Plan Format

    Uploaded by

    Christian
    11K views2 pages
    This discharge plan outlines instructions for a patient being discharged from the hospital. It includes the patient's diagnosis, surgery undergone, hospital and physician details. It provides objectives and guidelines for medications, exercises, treatments, health teachings, diet, spiritual needs, observed symptoms to report, and discharge details such as date and time, accompaniment, transportation, and condition. The instructions were explained and validated by the patient, relative and clinical instructor.

    Original Description:

    USC Discharge Plan Format

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    © Attribution Non-Commercial (BY-NC)

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    This discharge plan outlines instructions for a patient being discharged from the hospital. It includes the patient's diagnosis, surgery undergone, hospital and physician details. It provides objectives and guidelines for medications, exercises, treatments, health teachings, diet, spiritual needs, observed symptoms to report, and discharge details such as date and time, accompaniment, transportation, and condition. The instructions were explained and validated by the patient, relative and clinical instructor.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    11K views2 pages

    Discharge Plan Format

    Uploaded by

    Christian
    This discharge plan outlines instructions for a patient being discharged from the hospital. It includes the patient's diagnosis, surgery undergone, hospital and physician details. It provides objectives and guidelines for medications, exercises, treatments, health teachings, diet, spiritual needs, observed symptoms to report, and discharge details such as date and time, accompaniment, transportation, and condition. The instructions were explained and validated by the patient, relative and clinical instructor.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    Discharge Plan

    Name:________________________ Age: ____ Sex:____ Religion:_______________

    Diagnosis: ___________________ __ Surgery Undergone, if any:____________________

    ________________________ ____________________________

    Hospital: _____________________ Rm./Ward-Bed No. ___________Physician:______________

    A. Objectives

    B.
    1. Medications (attached a separate sheet for this purpose if needed)
    Name of drug Dosage and Route Curative Effects Side Effects
    Frequency

    2. Exercise / Activity
    Type of Activity Allowed / to be continued:__________________________________
    :__________________________________ __________________________________
    Procedure or Steps:
    _______________________________________________________________________
    _______________________________________________________________________
    __
    Use of Equipment (if any):__________________________________________________
    Restrictions:_____________________________________________________________

    3. Treatment (prescribed treatment to be continued at home or to a referred health institution.)

    4. Health Teachings (provide a separate sheet on specified health teachings)


    ( ) clinic appointments schedule ( ) use of alternative medicines
    ( ) follow up laboratory examinations ( ) relapse prevention measures
    ( ) understanding and knowing what to do with side effects of medications
    ( ) others __________________

    5. a.. Observed signs and symptoms that need reporting:


    ________________________________________________________________________
    ________________________________________________________________________
    b. Interventions / Home Remedies that may be done immediately prior to seeking
    consultation:________________________________________________________________
    __________________________________________________________________________

    6. Diet (prescribed by the doctor / dietician).


    a. Prescribed Diet:
    b. Restrictions:

    7. Spiritual and Psychological Needs


    ( ) Spiritual Counseling ( ) Confession ( ) Supportive Counseling
    ( ) Grief Work ( ) Family Therapy ( ) Join Organizations/ Church Activities
    ( ) Anger Management ( ) Reconciliation of Conflicted Relationships

    A. Discharge Details
    a. Date and Time of Discharge: __________________________________________________
    b. Accompanied by: ___________________________________________________________
    c. Mode of Transportation: ______________________________________________________
    d. General Condition upon Discharge: _____________________________________________
    __________________________________________________________________________
    __________________________________________________________________________

    THESE DISCHARGE INSTRUCTIONS WERE EXPLAINED TO THE PATIENT AND/ OR


    RELATIVE

    Read and Understood:

    _________________________________
    PATIENT/ RELATIVE
    (Signature over printed name)

    Validated:

    _________________________________
    STUDENT NURSE
    (Signature over printed name)

    _________________________________
    CLINICAL INSTRUCTOR
    (Signature over printed name)

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