EPIC – ETSU Discharge Summary Template

ETSU Discharge Summary Template

Patient Name:

MRN:

Admission Date:

Discharge Date:

Attending on Discharge:

Primary Care Physician:

Consulations:

include name & specialty

Primary Discharge Diagnosis:

Most pertinent dx for admission

Secondary Diagnoses:

Ancillary dx in addition to primary

Must include all diagnoses treated during hospital course

Don’t forget chronic illnesses addressed during admission

Procedures:

Include date performed

Diagnostics & Labs:

Relevant labs & radiology

Reason For Admission:

In one line, explain why patient was admitted, preferably with primary diagnosis

Ex. Patient admitted for NSTEMI

Hospital Course:

Brief explanation of the course, treatment, imaging, labs, & consults with patient’s disease course and progression of condition

Ex For HTN, patient was continued on amlodipine…for HLP, patient’s pravastatin changed to atorvastatin

Discharge Medications:

Include every single medication you have RXed on DC including home medications

Don’t forget to note ANY changes in home medications!

Ie: ADDED ASA, DISCONTINUED Plavix, CHANGED pravastatin to atorvastatin

Discharge Instructions:

Diet:

Activity:

Disposition: where the patient is being discharged to (home, nursing home, hospice)

Other: any special instructions given to the patient or that you would like PCP to know

If needed please include home O2 level, BIPAP/CPAP settings, wound care or tube feed instructions

Pending Lab/Radiology Studies:

Note any diagnostics pending on discharge and WHOM is to follow up on these

Ie: PET scan results, ANA, Lyme titers, etc.

Follow Up Appointments:

Always include a PCP appointment within 1-2 weeks of discharge

If needed please indicate recommended f/u studies here such as BMP, CXR, INR, CT & timeframe (in 1 week, 2 weeks, 3 months, etc)

Include appointments with consultants if applicable (name, specialty, time)

Condition on Discharge:

Stable / Fair / Guarded

Code Status:

Full / DNR / DNI

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