[Hospital Name]
[HospitalAddr1]
[Hospital Name][HospitalAddr1] |
| ER Discharge Summary |
| Patient Details | Admission Details | ||||
| Patient ID | : | [PatientID] | Date and Time of Admission | : | [DOA] |
| Patient Name | : | [PatientName] | Date and Time of Discharge | : | [DOD] |
| Gender/Age | : | [Sex] / [Age] | |||
| Address | : |
[Address1] [Address2] |
|||
| Mobile | : | [Mobile] | |||
| Chief Presenting Complaints |
| [Complaints] |
| Investigation Done |
| [Investigation] |
| Vitals |
| [Vitals] |
| Management in ED |
| [ManagementED] |
| Diagnosis |
| [Diagnosis] |
| Discharge Medication |
| [DischargeMedication] |
| Discharge Instructions |
| [DischargeInstructions] |
|
Follow-up in .........................................................................................OPD/ER with ................... [DoctorName] on ............with reports of ........................after taking priority. |
||
| For emergency assistance/enquiry please call 0471-2525666 & for OPD appointments please call 808611111 | ||
 MLC
|
Lama
|
Discharge at request
|
|
Patient/By Stander Signatur |
[Signature]
ER Doctor Signature |
|