DISCHARGE LETTER

[Hospital name and unit]
[Address]
[Direct phone for the discharging team, and fax or secure email]

Date: [Date sent]

To: [Family doctor or primary care provider's name]
[Practice, address, and fax or secure email]
Copies to: [Patient, specialist following up, pharmacy, or home care, as agreed with the patient]

Re: [Patient's full name]
Date of birth: [Date]
Hospital or medical record number: [Number]
Admitted: [Date]
Discharged: [Date]
Discharged to: [Home, home with services, rehabilitation, or another facility]

Dear [Dr. name or nurse practitioner name],

[Patient name] was in our care from [admission date] to [discharge date] with [main diagnosis]. The full discharge summary is [attached, or in the shared record].

WHAT WE ASK YOU TO DO
1. [The first request: the test, check, or decision, and by when]
2. [The next request, with a date or time frame]
3. [Prescriptions to renew, and the date the supply runs out]

REASON FOR ADMISSION AND DIAGNOSIS
Reason for admission: [Presenting problem and how the patient arrived, in one sentence]
Main diagnosis: [Diagnosis, and the key finding that confirmed it]
New problems found: [New diagnoses or complications during the stay, or none]

WHAT WE DID
Treatment: [Main treatments and procedures, with dates, in two or three lines]
Decisions made: [Changes to resuscitation status or goals of care, or none]
Condition at discharge: [Symptoms, walking, and the vital signs, weight, or results to compare against]

MEDICINE CHANGES
Started: [Drug, dose, how often, why, and for how long]
Changed: [Drug, old and new dose, and why]
Stopped: [Drug, and why, so it isn't restarted]
Allergies: [New allergies or reactions, labels removed, or no change]
Supply given: [Days supplied for each new medicine, and who renews it]

PENDING RESULTS AND FOLLOW-UP
Pending: [Each test, the date sent, why, and who will read the result and tell the patient]
Booked: [Clinics, tests, or calls already arranged, with dates]
Referrals: [Services referred to and why, or none]

WHAT THE PATIENT WAS TOLD
Diagnosis and plan: [What we explained, to whom, and in what language]
Warning signs: [Symptoms that should bring them back, and when to call 911 or go to the emergency department]
Limits: [Driving, work, lifting, or bathing, and until when]
Written information: [Discharge instructions, medicine list, or leaflets given]

Please call [name and direct number] with any questions.

Yours sincerely,

[Your name, credentials, and role]
[Attending physician, if different]
[Signature]