Patient Safety Tool: Patient Discharge Instruction Form

The Nebraska Hospital Association offers a free, downloadable patient instruction form to help patients better manage their health post-discharge.

The hospital association obtained the forms from the Critical Access Hospital Network, which is comprised of hospitals across the state, including Brown County Hospital in Ainsworth; Tri Valley Health System in Cambridge; Gothenburg (Neb.) Memorial Hospital; Valley County Health System in Ord and Good Samaritan Hospital in Kearney.

The instruction form allows the patient to see a list of medications and when to take them; scheduled appointments; physical activities; wound incision care; dietary restrictions and more.

Download the Critical Access Hospital Network's patient discharge instruction form (DOC) for use in your facility.

Note: View our database providing reports that link to free, downloadable and adaptable tools for use in hospitals, surgery centers and other organizations by clicking here.

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