Family Medicine Discharge Summary Template

Patient Clinic # and Name
Admit Date
Discharge Date
Admit Diagnosis

History of Presenting Illness - including subjective info from ER, objective findings that led to admission

Hospital Course - list problems encountered.  Start with admit diagnosis, then list issues encountered (anemia, hyponatremia, HTN, DM).  Mention consults obtained and imaging done.

Special Procedures - Angiogram, Vertebroplasty, lumbar puncture

Discharge Medications:

  1. Resume medications, specify dose changes
  2. Discontinued medications
  3. New Medications

Patient Condition - Stable, Non-weight bearing to SNF (include name of facility), hospice, etc.

Diet - Diabetic, Cardiac, Renal

Final Diagnosis - list admit diagnosis as well as problems encountered during hospitalizations

Follow Up - mention labs, studies, consults that are being ordered as an outpatient so taht the PCP knows what needs to be followed up.

Call individual clinic to make f/u appointment with PCP.  If PCP not available, then resident on inpatient service.  If inpatient resident not available, then any 2nd or 3rd year.

For Arrowhead, if PCP not available and pt needs to be seen in 2-3 days, then schedule with any attending.

Clinic Hotlines:
Arrowhead 623 561 0414 x125
Fountain Hills 480 837 2081 x 2125
Thunderbird 480 860 4818 x 1125

Send copy of dictation to PCP.