EXAMPLE DISCHARGE LETTER � GENERAL MEDICINE by robpearson

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									Stroke Patient Discharge Form
PATIENT                                        DoB/CHI

CONSULTANT                                     WARD


DATE OF ADMISSION                              DATE OF DISCHARGE

REASON FOR ADMISSION

MAIN DIAGNOSIS

OTHER ACTIVE                         1)                  2)
PROBLEMS                             3)                  4)


COMMENT ON THIS ADMISSION (brief results and pertinent commentary on
course in hospital)

CT result

RISK FACTORS ADDRESSED
Smoking:
Alcohol:
Weight:
Exercise:
Blood Pressure:
Cardiac Rhythm:
Cardiac Status:
Glucose:
Lipids:
Carotid Atheroma: LCCA          LICA
                     RCCA        RICA
Antiplatelet/Anticoagulant Regime:

FUNCTIONAL STATE ON DISCHARGE (if problem)
Mobility:                  Transfer to and from bed:               Manages
stairs:
Toileting:                 Dressing:        Grooming:
Bathing:                   Kitchen:         Feeding:
Continence (bladder):      Continence (bowels):




MCJ\medical letters\example discharge letter
DISCHARGE                         Destination
ARRANGEMENTS:                     Care arrangement
                                  Information given to
                                  patient
                                  Follow up review (if
                                  planned)
                                  OP investigations (if
                                  planned)
DRUGS ON DISCHARGE                DOSE           FREQUENCY   NOTES (amount)




Signature

Name                                                    Bleep No:
Grade
Counter signature by Consultant (if required))




MCJ\medical letters\example discharge letter

								
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