USM-KLE International Medical Programme

Nehru Nagar, Belgaum, Karnatka

Shadow House Officer Training Schedule (SHOTS)

Student Management Record (SMR)

DISCHARGE SUMMARY
Patient R/N : Age :
Patient Initials : Race :
Admission Date : Sex :
Discharge Date : Ward :

CHIEF COMPLAINTS

MAIN DIAGNOSIS ON DISCHARGE

CO-MORBIDITY

DISCHARGE SUMMARY
LIST OF RELEVANT INVESTIGATIONS / PROCEDURES

PLAN ON DISCHARGE
(1) Medications on discharge (2) Advice

(3) Appointment

Date: Time: Date: Time:

Student: Lecturer:

Signature: Signature:

FOR TRAINING AND EDUCATIONAL PURPOSES ONLY. THIS IS NOT AN OFFICIAL HEALTH
RECORD.