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