Newborn Discharge Summary Form
This convenient 3-ply form summarizes the condition and care of the infant prior to discharge and documents the health status of the infant upon discharge. "Memory joggers" help prevent errors of omission in charting and eliminate misinterpretation of handwriting. Key elements include:
• Medications
• Complications
• Lab Tests and Results
• Discharge Comments and Plan
• Follow-Up Care Instructions and Referrals
Ply one remains in the infant’s hospital chart; ply 2 is sent to the infant’s physician; ply 3 sent to mother’s physician.
• Medications
• Complications
• Lab Tests and Results
• Discharge Comments and Plan
• Follow-Up Care Instructions and Referrals
Ply one remains in the infant’s hospital chart; ply 2 is sent to the infant’s physician; ply 3 sent to mother’s physician.
8 1/2" x 11" (detached), 3-part snap set, white carbonless paper, green and black ink, 7-hole punched left and 5-hole punched top, wrapped in 50s.