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Discharge Instructions

  1. Patient's Name: ____________________________________
  2. Diagnosis: Your child's diagnosis is ____________________________
  3. Discharge Instructions:
    • For pain or fever over 102F (39C) give:

      ____ mg of acetaminophen every 4 to 6 hours OR

      ____ mg of ibuprofen every 6 to 8 hours

    • ______________________________________________________________
    • ______________________________________________________________
  4. Additional Instructions:
    • _______________________________________________________
    • _______________________________________________________
    • _______________________________________________________
  5. Follow-up Appointment after Discharge

    ___ Your child needs to be rechecked and has an appointment on _____________ at _______ with _________________________.

    ___ Your child needs to be rechecked in ________ days. Call your child's doctor to make an appointment.

    ___ A follow-up appointment is not necessary. Call your doctor if you have any concerns.

  6. Call your doctor if any of the following occur (phone: : ___________)
    • _______________________________________________________
    • _______________________________________________________
    • _______________________________________________________
  7. Caregiver's name __________________________ Date___________
Written by B.D. Schmitt, M.D., and Robert Brayden, M.D.
Published by McKesson Provider Technologies.
Last modified: 2005-02-23
Last reviewed: 2006-02-06
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Copyright 2006 McKesson Corporation and/or one of its subsidiaries. All Rights Reserved.
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