Discharge Instructions Form

Briggs Discharge Instructions documents instructions provided to the patient upon discharge including:

•         Follow-up appointments needed

•         Upcoming appointments already made

•         Medication instruction

•         Therapy program(s)

•         Diet instructions

•         Skin/wound care instructions

•         Follow-up with community resources/organization and other referrals

•         Other instructions

The form provides the contact number of the Physician or Care Manager for the patient/caregiver to contact with questions.   

This 2-part form is to be signed by Care Manager as providing the discharge instructions and Patient or Caregiver receiving the discharge instructions.

Part 1 is retained in the patient’s clinical record and Part 2 is given to the Patient/Caregiver.

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