Discharge Summary Template
Most Responsible Diagnosis (MRDx)
The one diagnosis responsible for the longest portion of the length of stay and impacts care and treatment of the patient
Pre-Admit Diagnoses (Community Acquired)
Any diagnosis in addition to the MRDx that exists before or on admission and impacts length of stay, care and treatment of the patient
Post-Admit Diagnoses (Hospital Acquired)
Any diagnosis that arose after admission to hospital and impacts length of stay, care and treatment of the patient
Secondary Diagnoses (Medical History)
Other diagnoses that are important to communicate for continuity of care and do not impact current patient stay
Interventions
Operative and nonoperative procedures performed that contribute to hospital course
Flagged Interventions
If the following interventions listed below were performed, they must be documented
| Cardioversion | ECMO | Per-orifice Endoscopy |
| Cell Saver | Endoscopic Percutaneous Biopsy | Pleurocentesis |
| Chemotherapy | Feeding Tube | Radiotherapy |
| Central Lines | Heart Resuscitation | TPN |
| (PICC/portacath) | Invasive Mechanical Ventilation | Tracheostomy |
| Dialysis | Paracentesis |
Code Status
Indicate the status of the patient with respect to the desire for resuscitation
Relevant Consultants
Physicians that provide advice and/or treatment regarding the patient's condition
Allergies
Identify known allergies of the patient
Medications on Discharge
Details of discharge medications including reasons for giving or altering medications, frequency, dosage and proposed length of treatment
Post-Discharge Follow-up
Instructions and specific plans after discharge including follow-up appointments with physicians and any further outpatient investigations
Discharge Disposition
The location where the patient was discharged to (home, nursing home, transferred to another facility) or the status of the patient on discharge
Treatment and Course in hospital
Brief summary of the management of each active medical problems during admission