Patient Safety Tool: Patient Discharge Planning Checklist From CMS

CMS has developed a free, downloadable discharge planning checklist for patients preparing to leave a hospital or other healthcare setting.


"Your Discharge Planning Checklist" is a six-page pamphlet which asks patients to answer more than a dozen questions including:

  • Ask where you will get care after discharge.
  • Ask about problems to watch for and what to do about them.
  • Ask if you will need medical equipment.
  • Ask the staff to show you and your caregiver any other tasks that require special skills like changing a bandage or giving a shot.


The pamphlet also allocates a space for noting medications and upcoming appointments.


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Download the patient discharge planning checklist (pdf) for use in your facility.


Note: View our database providing 90-plus reports that link to free, downloadable and adaptable tools for use in surgery centers, hospitals and other organizations by clicking here.


Related Articles on Patient Discharge:

Patient Safety Tool: Medication History/Discharge Order/Patient Instructions Form From Kearney County Health Services

Discharge One Day After Gastric Bypass Linked to Higher Mortality

Physicians Fall Short in Delivering Post-Discharge Instructions to ED Patients, Research Suggests

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