Patient Demographics
Name:
Age:
Sex:
Date of Birth:
Admitting Physician:
Admitting Service:
Date of Last Discharge:
Reason for Last Discharge:
Reason for Readmission (RR)
Clearly state the primary reason for the patient’s readmission in their own words if possible.
Include the duration of the symptoms leading to readmission.
Summary of Prior Admission
Briefly mention the patient’s prior admission date, admitting diagnosis, and significant events during that stay.
Include the discharge diagnosis and treatment plan from the previous admission.
History of Present Illness Since Discharge (HPI)
Onset: When did the new or worsening symptoms begin after discharge?
Progression: How have the symptoms changed since discharge?
Aggravating/Alleviating Factors: What makes the symptoms worse or better?
Medication Adherence: Assess how well the patient adhered to the discharge medication regimen and any other post-discharge instructions.
Identify any new medications or treatments initiated since discharge.
Current Assessment
Briefly summarize the patient’s current clinical status, incorporating pertinent findings from the history.
Mention any changes in vital signs or physical examination findings compared to the previous admission.
Assessment and Plan
Formulate a working diagnosis or differential diagnosis based on the current presentation and history of the previous admission.
Outline the revised treatment plan, considering medications, investigations, procedures, and potential adjustments to the discharge plan from the prior admission.
Address any factors that may have contributed to the readmission and plan interventions to prevent future readmissions.