PDF Version of Discharge Summary, Family Medicine
Discharge note format recommended for use when working with Dr. Streletz.
Admission Date:
Discharge Date:
Service: Service Name, Attending Physician, Residents
PCP or Referring Physician:
Discharge Diagnoses: E.g.
- Ventricular fibrillation with AICD at Discharge
- Chronic A. fib
- CAD
- Syncope 2/2 Ventricular Fibrillation
- Bradycardia
- ?HTN
Consultants: List physician, services, dates
Procedures Performed: List procedure type and dates performed, e.g.
- Pacer interrogation – 11/23/2014
- CT – 11/25/2014
- MRI – 11/26/2014
Hospital Course: Summary of treatment and progress during hospital stay, e.g.
80 y/o male presented with syncope x 2 admitted for work up. See H&P for further details. Cardiology was consulted at the time of admission. St Jude contacted for Pacer Interrogation. Pt was noted to be bradycardic.
Pt was seen and examined on the date of discharge.
Physical Exam at time of discharge:
Vitals at time of discharge:
Labs at time of discharge:
Discharge Medications: Discharge meds with dosage, administration, refills
Discharge Instructions
- Activity restrictions, diet, dressing and / or cast care, symptoms to warrant further treatment, etc.
- Follow up PCP: F/up appointment, emergency phone number, etc.
- Take Meds: Take medications as instructed.
“Patient understands that he is being discharged home in stable condition. Patient is follow up with the PCP in 5-7 days. Patient understands that if he develops the same symptoms as before, he needs to consult the emergency room for further evaluation and treatment.”
Discharge summary dictated by Dr. _______ (resident’s name) under the supervision of Dr.________ (attending’s name). The attending physician saw and evaluated the patient with me.