DISCHARGE ORDER

Patient Name :

Patient MRN : Age : Gender : Affix patient label here

Bed No. : Department and Unit :

Doctor’s Order

Diagnosis :

Procedure Performed :

Patient is fit to discharge after assessment and seeing all the post procedure investigations report.

Doctor Name and Signature : Nurse

Name and Signature :

Date : Time :

Patient and Family Declaration

I have been explained all the discharge instructions in the language I understand about :

Medication
Follow up advice
Next visit details
How to obtain emergency care and emergency contact number
Diet and preventive aspects of care
Availability of discharge summary CD (if applicable)
WARFARIN (If Applicable)
Diabetic education (If Applicable)

Patient Name Signature : MRN No. :

Relative Name and Signature: Relationship :

Nursing Staff Name and Signature

E. Code :

Date : Time :
 CHECK LIST BEFORE DISCHARGE
(Nurses’ Responsibility)

Before Billing

All investigations and treatment included in the billing sheet.

Hand over time of billing sheet is documented.

Patient-owned medication has been returned to pharmacy and the refund amount processed. (check the medication
in refrigerator before return)

In-charge nurse counter checks the returning of drugs.

The relatives are informed by the nursing staff about the patient’s discharge.

After Billing before Patient leaves hospital

Patient I.D. Band removed.

I.V. Line (I.V. Cannula) / Central line removed.

Report of histopathology / CT MRI file / CT-CD etc checked and handed over to patient.

Suture removed from operating site / drainage / lines.

Finance Clearance slip received.

Medicine prescription explained to patient / relatives. (Which includes

abbreviation like SOS / TID / BD/ OD)

Discharge summary explained to patient / relatives and signature obtained.

Checked by Name / Signature Counter signed by Name / Signature