Hospital Discharge Notification and Tracking Log

Log hospital and emergency department discharge notifications and track primary care follow-up status, outreach, and completion.

Notification Details

• Notification received date
• Notification received time
• Notification source
• Source facility name
• Notification method

Patient and Discharge Summary

• Patient identifier
  Use the internal medical record number or other internal identifier. Avoid collecting SSN or other unnecessary identifiers.
• Patient name
• Discharge date
• Discharge type
• Primary discharge diagnosis
• Discharge summary available?

Follow-Up Needs

• Is follow-up needed?
• Follow-up priority
• Recommended follow-up timeframe
• Reason follow-up is needed

Outreach and Scheduling

• Assigned staff member
• First outreach date
• Number of contact attempts
• Follow-up appointment scheduled?
• Appointment date
• Appointment type
• Barriers to follow-up

Status, Escalation, and Audit Trail

• Current status
• Readmission risk flagged?
• Escalation needed?
• Escalation notes
• Follow-up completed date
• Audit trail notes
  Briefly note key actions taken, including outreach attempts, appointment scheduling, and any unresolved items.