DISCHARGE NOTE

PATIENT NAME: …………………………...PATIENT UID…………
AGE: ………………….

GENDER: ……………….

DATE OF PROCEDURE………………….

DATE OF DISCHARGE…………….

DISCHARGE:Recovered/LAMA/ Discharge on request.
REASON FOR CHECK IN –

MEDICAL HISTROY-

PROCEDURE PERFORMED–

INVESTIGATIONS –

CONDITION AT THE TIME OF CHECKOUT –

MEDICATION/PRODUCTS PROVIDED –

FOLLOW UP ADVICE –

DOCTORS NAME-

SIGNATURE-

DATE-

TIME-

In case of any problem please contact Darling Buds Phone No. 9814531111, or E Mail at : justfue@gmail.com

Discharge note

  • 1.
    DISCHARGE NOTE PATIENT NAME:…………………………...PATIENT UID………… AGE: …………………. GENDER: ………………. DATE OF PROCEDURE…………………. DATE OF DISCHARGE……………. DISCHARGE:Recovered/LAMA/ Discharge on request. REASON FOR CHECK IN – MEDICAL HISTROY- PROCEDURE PERFORMED– INVESTIGATIONS – CONDITION AT THE TIME OF CHECKOUT – MEDICATION/PRODUCTS PROVIDED – FOLLOW UP ADVICE – DOCTORS NAME- SIGNATURE- DATE- TIME- In case of any problem please contact Darling Buds Phone No. 9814531111, or E Mail at : justfue@gmail.com