Discharge Summary Template

Patient Information:
- Name / MRN:
- Admission Date:
- Discharge Date:

Attending Physician:

Diagnoses:
- Primary:
- Secondary:

Hospital Course Summary:
- Reason for Admission:
- Key Diagnostics:
- Treatments/Procedures:
- Response to Therapy:

Procedures Performed:

Medications at Discharge:
- Continue:
- New:
- Discontinued:

Follow-up Plan:
- Appointments:
- Pending Tests/Results:
- Specialist Referrals:

Patient Instructions:
- Activity:
- Diet:
- Warning Signs:
- Home Services:

Disposition:

Sign-off:
- Discharging Provider Signature  Credentials
- Date / Time