Patient demographics | Patient name, MRN |
Date of birth | |
Gender | |
Primary care provider | |
Visit | Admit date |
Discharge date | |
Most responsible health care provider name and contact information | |
Name of individual completing summary | |
Date completed | |
Discharge location | |
Death (yes, no) | |
Encounter location | Hospital name |
Hospital type | |
Alert indicators | Allergies |
Course while in hospital | Presenting complaint(s) |
Summary of key results, investigators, interventions, and advance directives | |
Adverse events and complications | |
Discharge plan | All medications at discharge |
Follow-up instructions for patient | |
Follow-up plan recommended to be implemented by the receiving provider | |
Referrals | |
Copied to with contact information |