MY DISCHARGE INSTRUCTIONS
Instructions
n Do I know why I was admitted to the hospital? ____________________________________________________ n Do I know where I am going when I’ m discharged? ________________________________________________ n What are my discharge instructions? ____________________________________________________________ n Do I have any restrictions and, if so, what? _______________________________________________________ n Do I understand my restrictions? ________________________________________________________________ n Who do I call if I have questions? _______________________________________________________________ n What is the phone number? ____________________________________________________________________ n When should I call( reason)? ____________________________________________________________________
Medication list n Did I get my discharge medication list?___________________________________________________________ n Do I understand what medications to take, when, and how much?___________________________________ n Do I understand what the medications are for?____________________________________________________ n If I need any prescriptions, do I have them or have they been sent to my pharmacy? __________________
Appointments n These may be on my discharge papers. If they are not on my discharge papers, what follow-up appointments should I have and with whom? _____________________________________________________ n What do I need to bring to the appointment? _____________________________________________________ n Who do I call if I need to schedule or reschedule an appointment? __________________________________ n What is the number? __________________________________________________________________________ n Have I been given all of my follow-up instructions?_________________________________________________ n Do I understand them?_________________________________________________________________________
APPOINTMENTS
Date: Time: Location: With Whom?
Purpose / Notes:
Date: Time: Location: With Whom?
Purpose / Notes:
Date: Time: Location: With Whom?
Purpose / Notes: uabmedicine. org 43