Discharge Summary Note
Date of Admission:
Date of Discharge
Principal Diagnosis:
Secondary Diagnosis:
Discharge Diagnosis:
Attending Physician:
Surgeon:
Procedure(s) Performed with Dates:
Chief complaint
HPI
Allergies
Medications on admission (home meds)
PMH
PSH
OB & GYN hx if applicable
FH
SH
Hospital Course: PE on admission, labs/dxtic on admit, admit diagnosis, inhospital course, consults
Condition on Discharge: VS, Labs.
Disposition:
Discharge Instructions: List medications, diet, follow-up care, activity restrictions.
Your name, position, and pager number
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