My Care Diary
Care team members:________________________________________________________________________________________
RESOURCES
Medications or procedures:__________________________________________________________________________________
Questions or notes:_________________________________________________________________________________________
____________________________________________________________________________________________________________
Discharge Instructions
Your care team will review the information below with you. For care partners, it is extremely important that you make plans to be at the bedside when discharge instructions are discussed, so you can learn how to help your loved one. You will need time to learn about and practice any special care needs such as changing dressings, turning and skin care, feeding tubes, or giving shots.
• My expected discharge date is:_____________________________________________________________________________
____________________________________________________________________________________________________________
• I was admitted to the hospital for:__________________________________________________________________________
____________________________________________________________________________________________________________
• When I am discharged from the hospital, I will go:____________________________________________________________
____________________________________________________________________________________________________________
• My discharge instructions are:_____________________________________________________________________________
____________________________________________________________________________________________________________
• If I have any restrictions, they are:__________________________________________________________________________
____________________________________________________________________________________________________________
• If I have questions, I should call:____________________________________________________________________________
____________________________________________________________________________________________________________
• I should always call if I experience:__________________________________________________________________________
____________________________________________________________________________________________________________
• If my appointments are not on my discharge papers, what follow-up appointments should I have and with whom?
____________________________________________________________________________________________________________
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