Dictation Discharge Summary
Save, fill-In The Blanks, Print, Done!
Download Dictation Discharge Summary
Adobe Acrobat (.pdf)- This Document Has Been Certified by a Professional
- 100% customizable
- This is a digital download (277.17 kB)
- Language: English
- We recommend downloading this file onto your computer.
How to draft a Dictation Discharge Summary? An easy way to start completing your document is to download this Dictation Discharge Summary template now!
Every day brings new projects, emails, documents, and task lists, and often it is not that different from the work you have done before. Many of our day-to-day tasks are similar to something we have done before. Don't reinvent the wheel every time you start to work on something new!
Instead, we provide this standardized Dictation Discharge Summary template with text and formatting as a starting point to help professionalize the way you are working. Our private, business and legal document templates are regularly screened by professionals. If time or quality is of the essence, this ready-made template can help you to save time and to focus on the topics that really matter!
Using this document template guarantees you will save time, cost and efforts! It comes in Microsoft Office format, is ready to be tailored to your personal needs. Completing your document has never been easier!
Download this Dictation Discharge Summary template now for your own benefit!
RE CHF: For each, be sure to clarify: □ What the problem is: Diagnosis, severity and prognosis (if relevant) □ Plans for managing problem: o Current therapies Planned therapies Planned/Pending investigations What has been discussed with the patient/family (Goals of Care, resuming activities, lifestyle changes, monitoring issues (sugars, daily weights etc.) and prognosis (when relevant ) Who will provide follow-up, what they will be doing and why for example: “Because of the risk of hyperkalemia and worsening renal dysfunction, we have asked the family doctor to re-check electrolytes in two weeks” For things you expect others to do, ask the transcriptionist to “Bold that” Also be sure to indicate: o Disposition (nursing home etc.) o Services arranged (CCAC etc.) Abbreviated Dictation Format Introduction: Identify self, role, date, patient name, PIN and their D.O.B.. Re Diabetes:) • State final opinion of what problem is • Plans for managing problem: - Current/Planned therapies - Planned/Pending investigations - What patient/family have been told - Who will provide follow-up and what they will be doing Also indicate: - Disposition (nursing home, home etc.) - Services Arranged (home care etc.) Gynaecology – New Consult LONDON HEALTH SCIENCES CENTRE VICTORIA HOSPITAL Surname, Given Name PIN: 1234 56 78 DOB: 1958/05/31 Copy for: Dr. Akhtar, Saima CONSULTATION cc: Dr. Saima Akhtar, VH 1234 56 78 Dr. J.. Sincerely, Saima Akhtar, MD, FRCSC Department of Obstetrics Gynecology D: April 21, 2010 T: April 23, 2010 SA/bb Job No: 2634965/1776188 Akhtar, Saima MD, FRCSC Signed on: 2010/05/03 17:26 Akhtar, Saima MD, FRCSC Authenticated on: 2010/05/03 17:28 Gynaecology – Discharge Summary Sample: Discharge Summary (Gynecology) Discharge Summary Surname, Given Name – 1234 56 78 Preliminary Report Result type: Discharge Summary Result date: April 30, 2010 Result status: transcribed Result Title: DISCHARGE SUMMARY Performed by: Jones, Jane on May 4, 2010 16:38 Encounter in
DISCLAIMER
Nothing on this site shall be considered legal advice and no attorney-client relationship is established.
Leave a Reply. If you have any questions or remarks, feel free to post them below.
Related templates
Latest templates
Latest topics
- Christmas Templates
Christmas is coming soon... Be prepared with nice Christmas letters, invitations, social posts etc and check out these Christmas templates now! - IT Security Standards Kit
What are IT Security Standards? Check out our collection of this newly updated IT Security Kit Standard templates, including policies, controls, processes, checklists, procedures and other documents. - GDPR Compliance Templates
What do you need to become GDPR compliant? Are you looking for useful GDPR document templates to make you compliant? All these compliance documents will be available to download instantly... - Invoice Templates
What exactly is an invoice, and what is the difference between the terms “receipt” and “bill”? Check out our Invoice, Bill & Receipt templates. - Best Calendar Templates
How do you make a nice calendar? Are you looking for nice calendar templates in MS Word, Excel or PowerPoint to improve your personal efficiency and effectiveness? These easy to modify calendar templates can help you out!
cheese
