Hospital Discharge Form Template for Canada

A Hospital Discharge Form is a crucial medical-legal document used throughout Canadian healthcare facilities to document and communicate the termination of a patient's hospital stay and transition to another level of care. This document, governed by both federal and provincial healthcare legislation, serves as an official record of the patient's condition upon discharge, treatment received, medication instructions, and follow-up care requirements. It includes essential information for continuity of care while ensuring compliance with Canadian health information privacy laws and provincial healthcare regulations.

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What is a Hospital Discharge Form?

The Hospital Discharge Form is a standardized document used across Canadian healthcare facilities when releasing patients from hospital care. It serves multiple critical purposes: documenting the patient's medical status and treatment received, providing clear instructions for ongoing care, ensuring proper communication between healthcare providers, and meeting legal and regulatory requirements for hospital documentation. The form must comply with provincial healthcare legislation and federal privacy laws, including the Personal Information Protection and Electronic Documents Act (PIPEDA) and provincial health information privacy acts. It is typically initiated by the attending physician or discharge planning nurse and requires various stakeholder inputs before the patient's departure. The Hospital Discharge Form becomes part of the patient's permanent medical record and serves as a reference for future care providers, insurance purposes, and potential legal matters.

What sections should be included in a Hospital Discharge Form?

1. Patient Information: Basic identification including full name, date of birth, health card number, and contact details

2. Admission Details: Date of admission, reason for admission, and primary diagnosis

3. Discharge Information: Date and time of discharge, discharge diagnosis, and condition at discharge

4. Medication Summary: List of current medications, dosages, frequency, and any changes made during hospitalization

5. Follow-up Care: Scheduled appointments, recommended specialists, and timeline for follow-up care

6. Care Instructions: Specific instructions for self-care, activity restrictions, and warning signs to watch for

7. Healthcare Provider Information: Names and contact information for attending physician and other relevant healthcare providers

8. Emergency Contact: Name and contact information for patient's emergency contact or next of kin

What sections are optional to include in a Hospital Discharge Form?

1. Medical Device Instructions: Used when patient is discharged with medical devices or equipment, including usage and maintenance instructions

2. Wound Care: Include when patient has surgical wounds or requires specific wound care instructions

3. Dietary Restrictions: Added when patient requires specific dietary modifications or restrictions

4. Physical Therapy Plan: Include when patient requires ongoing physical therapy or rehabilitation

5. Mental Health Follow-up: Used for patients with mental health conditions requiring ongoing care

6. Social Services Referral: Include when patient requires community support services or social work follow-up

7. Transportation Arrangements: Used when special transportation needs or arrangements are required

8. Interpreter Services: Include when patient requires language interpretation or communication assistance

What schedules should be included in a Hospital Discharge Form?

1. Medication Schedule: Detailed medication timing and instructions, including any necessary tapering schedules

2. Exercise Program: Illustrated guide of prescribed exercises and physical activity recommendations

3. Diet Plan: Detailed nutritional guidelines and meal planning recommendations

4. Home Care Schedule: Schedule of home care visits and services if applicable

5. Medical Equipment Instructions: Detailed technical instructions and maintenance guidelines for any prescribed medical equipment

6. Community Resource List: Contact information and details for recommended community support services

7. Follow-up Appointment Schedule: Calendar of scheduled follow-up appointments with various healthcare providers

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Medical Work Release Form

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Generate a Bespoke Document

Download a Standard Hospital Discharge Form

Review your own Hospital Discharge Form

What is a Hospital Discharge Form?

What sections should be included in a Hospital Discharge Form?

What sections are optional to include in a Hospital Discharge Form?

What schedules should be included in a Hospital Discharge Form?

Authors

Alex Denne

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