|
Discharge/Transfer Summary
|
|
|
Admission date
|
Discharge/transfer date
|
|
Discharge/transition Type
|
|
|
Discharge Summary
|
|
|
Discharged to
|
|
|
Transportation
• • •
|
|
|
Recommendations/Required Services
|
|
|
Include name, address, phone, and location
|
|
|
Presenting condition
|
|
|
Services Provided
• • •
|
|
|
Status of last contact
|
|
|
Reason For Discharge Explanation
|
|
|
Goal/s met
|
|
|
SNAP: Strengths, Needs, Abilities, Preferences
|
|
|
STRENGTHS
• • •
|
|
|
NEEDS
• • •
|
|
|
ABILITIES
• • •
|
|
|
PREFERENCES
• • •
|
|
|
SNAP: Strengths, Needs, Abilities, Preferences
|
|
|
Notifications
• • •
|
|
|
Medications left with
|
|
|
Presenting Condition
|
|
|
ELECTRONIC SIGNED FIELD
|
|
|
signed by pin#
|
|
|
signed by pin#
|
|
