Discharge summary

Setting: Inpatient

ADMISSION DATE: [date]    DISCHARGE DATE: [date]

PRINCIPAL DIAGNOSIS:
[Diagnosis]

SECONDARY DIAGNOSES:
[List]

HOSPITAL COURSE:
[Brief problem-based narrative]

PROCEDURES:
[List or none]

CONDITION AT DISCHARGE:
[Condition, functional status]

DISCHARGE MEDICATIONS:
[New / changed / stopped / continued]

FOLLOW-UP:
[Appointments, pending results, responsible clinician]

PATIENT INSTRUCTIONS:
[Diet, activity, return precautions]