Nursing Home Discharge Summary
This Nursing Home Discharge Summary serves as a comprehensive record of the patient's stay and care plan upon discharge. Use it to ensure continuity of care, follow-up appointments, medication management, and adherence to special instructions for optimal patient outcomes.
Name: | |
|---|
Date of Birth: | |
|---|
Gender: | |
|---|
Admission Date: | |
|---|
Discharge Date: | |
|---|
Primary Care Physician: | |
|---|
Next of Kin/Contact: | |
|---|
Diagnosis: | |
|---|
Secondary Diagnosis: | |
|---|
Reason for Admission: | |
|---|
Medical History
Summarize relevant medical history.
Treatment and Care Received
Describe any treatment and care received (include frequency and focus areas).
Physical Therapy: Daily sessions focusing on mobility and strength |
Functional Status
Describe the mobility status, level of assistance needed, feeding abilities, and continence status.
ADLs (Activities of Daily Living) |
Mobility: | Requires walker, able to walk short distances with assistance |
Hygiene: | Needs assistance with bathing and dressing |
Feeding: | Independent, uses adaptive utensils |
Continence: | Incontinent, uses adult diapers |
Cognitive Status
Describe the cognitive status, including orientation and memory.
Oriented to person and place, occasional memory lapses |
Discharge Plan
List all medications and details of any follow-up appointments.
Medications: | Amlodipine 10 mg daily |
Follow-up Appointments: | Primary Care Physician: [Month, Day, Year] |
Home Health Care Services: | Visiting Nurse: Twice weekly for wound care and medication management |
Special Instructions: | Low-sodium diet |
Recommendations/Considerations
List any recommendations or considerations for ongoing care, such as monitoring for signs of infection.
Monitor for signs of infection at the surgical site |
Comments/Notes
Add any additional comments or notes for progress and discharge plan.
Patient has shown significant improvement in mobility and speech |
Nursing Home Templates @ Template.net
