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Discharge information capture sheet

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Inspired Comforts Toolkit

Hospital discharges happen quickly. The nurse explains everything; half of it is gone by the car. Use this sheet to capture the essentials at the bedside. Have someone fill it in while you listen.

Discharge basics

Date of discharge
Discharging nurse / doctor name
Procedure / reason for admission

Medications going home with

Medication Dose How often What it’s for

Activity restrictions

Lifting limit (lbs)
Driving — when can I?
Showering / bathing instructions
Wound care instructions
Other restrictions

Follow-up appointments

Provider Date / time Phone Address

Red flags — call right away

Symptoms requiring same-day call
Phone number to call
After-hours / urgent number
By the Inspired Comforts editorial team · inspiredcomforts.com

For inspiration only. Customize for your situation. Always consult your medical team. Inspired Comforts is not a medical provider.

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