Nursing Home Discharge Summary

This Nursing Home Discharge Summary serves as a comprehensive record of the patient's stay and care plan upon discharge. Use it to ensure continuity of care, follow-up appointments, medication management, and adherence to special instructions for optimal patient outcomes.

Name:
Date of Birth:
Gender:
Admission Date:
Discharge Date:
Primary Care Physician:
Next of Kin/Contact:
Diagnosis:
Secondary Diagnosis:
Reason for Admission:

Medical History

Summarize relevant medical history.

Allergies: Penicillin

Treatment and Care Received

Describe any treatment and care received (include frequency and focus areas).

Physical Therapy: Daily sessions focusing on mobility and strength

Functional Status

Describe the mobility status, level of assistance needed, feeding abilities, and continence status.

ADLs (Activities of Daily Living)
Mobility:	Requires walker, able to walk short distances with assistance
Hygiene:	Needs assistance with bathing and dressing
Feeding:	Independent, uses adaptive utensils
Continence:	Incontinent, uses adult diapers

Cognitive Status

Describe the cognitive status, including orientation and memory.

Oriented to person and place, occasional memory lapses

Discharge Plan

List all medications and details of any follow-up appointments.

Medications:	Amlodipine 10 mg daily
Follow-up Appointments:	Primary Care Physician: [Month, Day, Year]
Home Health Care Services:	Visiting Nurse: Twice weekly for wound care and medication management
Special Instructions:	Low-sodium diet

Recommendations/Considerations

List any recommendations or considerations for ongoing care, such as monitoring for signs of infection.

Monitor for signs of infection at the surgical site

Comments/Notes

Add any additional comments or notes for progress and discharge plan.

Patient has shown significant improvement in mobility and speech