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Hospital Medical Report
This form is to be completed by the patient’s hospital doctor
Private & Confidential
Patient’s Name
Date of birth
Ward
Hospital
Consultant
Dear Doctor
The above patient, who is currently an in-patient under your care, is due to be admitted to one of our care homes. In order that
we can safely look after him/her, we need you to send us information about his/her medical history.
Please can you send a discharge summary, including the following information:
When were they admitted to your hospital?
Reason for admission and medical diagnosis
Past medical history (if known)
Progress on ward
Current clinical condition