Discharge Summary Template 2Discharge Summary Template 2
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Inova Fairfax Hospital Department of Medicine
Suggested Discharge Summary Format
(Modified from OU-Tulsa Department of Internal Medicine)
Patient Name:
Admission Date:
Discharge Date:
Attending Physician:
Dictating Physician:
Admitting Diagnosis:
Discharge Diagnosis:
Principal discharge diagnosis (reason for hospital stay after hospital assessment)
Other discharge diagnoses which were addressed during hospital stay (Complete list of
active problems addressed during hospital stay)
Consultations: (name and specialty)
Procedures: (Name of procedure and concise description of results, only major studies)
Complications (for primary and other discharge diagnoses):
History and Hospital Course:
A concise summation of clinical course. Begins from time of admission with a brief summary (one paragraph) of key
data from H&P. Then, use a problem-oriented approach by writing a separate paragraph for each problem title
followed by a short synopsis of the evaluation, treatment and progress of each pro