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10+ Patient Discharge Form Examples [ Hospital, Medical, Self ]


At some point in our lives, we may all have encountered, filled out or even held on to a discharge form. Whether it is from a hospital, a clinic or even from a small hospital. It may be for us, for a different patient or for someone you know. The whole point is the fact that we are no strangers to what a discharge form is and what its uses are. The only thing we may not be able to know or understand is why you still need to have a discharge form to get out of the hospital and why it is only used for patients. To get the answers you want to seek, here are some examples of patient discharge forms for you to check out. With that, let’s take a look at the examples, the purpose and the tips to help you.

10+ Patient Discharge Form Examples

1. Patient Discharge Care Notification Form

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File Format
  • PDF

Size: 1 MB

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2. Facility Patient Discharge Form

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File Format
  • PDF

Size: 86 KB

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3. Outpatient Discharge Summary Form

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  • PDF

Size: 335 KB

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4. Discharge of Voluntary Patient Form

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  • PDF

Size: 31 KB

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5. Utilization Management Patient Discharge Form

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  • PDF

Size: 226 KB

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6. Patient Admission & Discharge Form

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  • PDF

Size: 143 KB

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7. Patient Post Discharge Form

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  • PDF

Size: 65 KB

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8. Patient Discharge Planning Summary Form

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  • PDF

Size: 38 KB

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9. Patient Post Discharge Followup Documentation Form

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  • PDF

Size: 99 KB

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10. Patient Self Discharge Medical Advice Form

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  • PDF

Size: 157 KB

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11. Sample Patient Discharge Form

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File Format
  • DOC

Size: 6 KB

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What Is a Patient Discharge Form?

A patient discharge form is a kind of form that doctors, nurses or even the patient or the representative of the patient has to fill out in order for them to be discharged from the hospital. The discharge form is an important document and an important tool for doctors, nurses and for the patient themselves in order to get a go signal from the hospital that everything is okay.

In addition to that, a patient discharge form is also used as a basis in their files as the discharge form gives out information that is important for their files and for the file of the patient. If there are any issues that may have to be taken into consideration or to give a reason for the discharge, they will base it from the form. Lastly, a patient discharge form is also an important document as it summarizes the overall status of the patient and to see if they are fit enough to be taken out of the hospital.

How to Make a Patient Discharge Form

There are a lot of uses for forms, and each use for them has its own purpose. We may not be able to know how they are made since when they are presented to us, they are already in the complete details and all we have to do is to fill it out. However, when you are given the chance to make a patient discharge form from scratch, here are things you can take notice of. 

1. General Information of the Patient

The information of the patient is often the first thing that you will need in order to make the patient discharge form. General information here will mean the name of the patient, the room number, the name of the hospital, the date of the patient being admitted and the date of their discharge. The parent or the representative who is with the patient and of course the name of the physician.

2. The Purpose of the Patient Being Admitted

The next thing is the purpose of the patient being admitted. This is an important factor in the making of a patient discharge form. This is the very reason to have a discharge form. So when you want to make the discharge form, make sure that the purpose of the patient being admitted is present. As this is also going to be important in the next step.

3. Findings and Procedures Being Done

Next thing is the findings and the procedures being done will be based on the purpose of the patient being admitted. The findings are also necessary so that the patient may know whether or not they are able to get out or are they going to be staying for a little while longer. The procedures being done are optional but it is also best to be written down in the form. 

4. The Person in Charge’s Signature Below

Lastly, the patient discharge form can only be done when all of that is done, and the physician’s signature is also present. As the physician’s name, signature and date are required. The patient cannot be discharged with the agreement of the physician. 

FAQs

What is a patient discharge form?

A patient discharge form is a kind of form that doctors, nurses or even the patient or the representative of the patient has to fill out in order for them to be discharged from the hospital.

Why is it necessary for the discharge form to have a physician’s signature?

The physician in question is the only person who can give the head’s up or to agree if they believe that the patient is okay to be discharged and continue their medical care at home.

How do you start a discharge form?

The most important part is the information of the patient.

What is usually the first thing that comes to your mind when you hear a form. Often than not, the first thing that usually pops into your head is a piece of paper that you have to fill out in order to get something out of it. Forms come in all shapes, sizes and of course uses. We also know that a discharge form is often connected with medical, hospital, or for a patient waiting to be given the go sign. Think of it like a nursing assessment.

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