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Notification and Summary of Discharge

NOTE: Copy 1 to be sent to GP, copy 2 MUST be attached to the drug chart, copy 3 to be handed to the patient

Dear Dr.

G.Patel

GPs ADDRESS

UNIT No.

12345
NAME A. Patient
DATE OF BIRTH 12/10/45
ADDRESS : 26 High Street, Newtown

10 Railway Cuttings
Medway
WARD
Anson
CONSULTANT A.Consultant
ADMITTED ON 24/10/10

DISCHARGED ON 29/10/10

DISCHARGED TO
HOME

x
HOME WITH CARE PACKAGE
HOME WITH COMMUNITY NURSING
FOLLOW UP DATE
GP appointment
Diagnosis
Co-existing problems

* If discharged to one of these please state details


* Nursing home
Residential care home
* Specify here

Haematemesis
UTI

Operation / Treatment summary:


Allergies:
Pharmacy
use only

Date
Prescribed

DRUG
(in CAPITALS)

Route

Dose and
Frequency

Duration

Doctors
signature

29/10/10
29/10/10
29/10/10
29/10/10

Aspirin
Omeprazole
Trimethoprim
Zopiclone

Po
Po
Po
PO

75mg mane
20mg mane
200mg BD
7.5mg nocte

1/12
1/12
5/7
1/12

A. Doctor
A. Doctor
A. Doctor
A. Doctor

Yours sincerely
Medical Officers Name and Grade
(CAPITALS) A.Doctor
FY2

Medical Officers Signature

A.Doctor
Full summary to follow

No

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