Discharge of a Patient Checklist

Make sure Physician has ordered the discharge

Remember to WIPE and verify the patient

Help patient dress if necessary

Help collect patient's personal belongings

Pack, make sure all pt. Belongings are removed from the room,
check medications, verify that the pt. Has received discharge paper
Assist patient into wheelchair

Assist patient to discharge entrance of the facility

Help pt. Into vehicle, say goodbye, return wheelchair
Return to patient unit and dispose of linens and clean and replace equipment used in care
for the patient

Wash hands

Record discharge
Time
Method of transport
Patient's reaction
Signature

Report completion of task to nurse.

Discharge Form: Medical record number:

Patients First Name: Last: MI:
I hearby release: To release Information to:
(individual name, facility/organization and address)

St. Lukes Hospital

St. Lukes Clinic

Purpose of Disclosure:

Continuing care

Payment of claim

School

Workers comphensation

Legal

Personal use

Other:

Information to be Released: between dates of: and:

Discharge Summary

H&P Exam/Initial Evaluation

Consultation Report

Conselour/therapist summary
Acknowledgement of Understanding:
I understand the expiration date of this authorization is one year.
 I understand that I may revoke this authorization at any time by notifying the providing organization
in writing, and it will be effective on the date notified except to the extent action has already been taken.
I understand that information used or disclosed pursuant to this authorization may be subject to
redisclosure by the recipent and no longer be protected by Federal privacy regulations.
I understand by authorizing this use or disclosure of information, there will be no conditions placed
on my health care or payment for my health care.
I understand that in compliance with MN statue 144-292 and WI administrative code HHS17, i may
be required to pay a fee for retrival and photocopying of records and/or supervising inspection of medical
records.
I understand that my medical information may include information relating to sexually transmitted
disease, sickle cell anemia, AIDS, HIV, behavioral or mental health services and treatment for alcohol and
drug abuse.
Psychotherapy notes will not be released per facility policy and HIPAA privacy rules, 45 CFR Parts
160 and 165, 502.

Signature of patient, parent of minor, personal representive relationship date Phone

Discharge

1. What kinds of challenges to patients and families face during Discharge?

Patients and family may face medical bills and hospital charges when being discharged.
2. Can this be a stressful time for a patient and their family? Why or Why not?
Yes, if patients or families are being rushed or if the process goes too slowly.
3. What can a Nursing Assistant do to alleviate or ease any challenges or stressors.
To ease the discharge process for patients CNAs can; help patients pack, check for any medical equipment
to be sent with patient, escort patients out of hospital
4. Can the Nursing Assistant affect the hospital experience for the patient? How?
Yes, if a NA helps the patient leave and makes a lasting impression, it may make the patient want to
return.

Group members:
Mariah Hodge
Tori bates
Madison Matherly
Hysain
Tmarra