Surgical Discharge Summary Template

Patient Information:
- Name / MRN:
- Procedure Performed:
- Surgeon:
- Date of Surgery:

Hospital Course:
- Indication for Surgery:
- Key Intra/Post-Operative Events:
- Complications:

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

Wound Care Instructions:

Activity Restrictions:

Dietary Guidance:

Follow-up Plan:
- Surgeon Visit:
- Primary Care:
- Therapy/Rehab:
- Pending Results:

Warning Signs / Return Precautions:

Equipment / Home Services:

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