Discharge Plan For the discharge plan, you will create a fictitious patient with your chosen chronic illness and usethis Discharge Plan documentto create a discharge plan for that patient. You are to

I. ASSESSMENT

Name: Click here to enter text.	DOB: XX/XX/XXXX
Date of Admission:	Assessment Date:
Admitting Diagnosis: Click here to enter text.	Past Medical History (include surgical history) Click here to enter text.
Subjective history of current hospitalization (what led to current hospitalization?)
Family and social history Click here to enter text.
Summary of physical assessment (complete head-to-toe from hospitalization documentation) Click here to enter text.
Allergies: Click here to enter text.

Effects of diagnosis on daily living: Click here to enter text.

Current Medications (to add rows, click “insert row” on Table Layout tools)

Activity of Daily Living and Instrumental Activity of Daily Living Assessment (Place an “X” in the appropriate column)

Patient Support System (based upon above assessment, who is available to provide care or support to patient)

Medical Follow-up

Click here to enter text.

Financial Summary

Click here to enter text.

II. DIAGNOSIS/PLAN

List your top three priorities, create a nursing diagnosis, and create two goals for each

III. EDUCATION NEEDS

IV. FINANCIAL WORKSHEET

Subtotal

Future Medical Care - Specialty
Description	Frequency	Purpose	Cost per visit	Cost per year

Subtotal

Future Medical Care – Treatment Interventions
Recommendation	Frequency of procedure	Purpose	Cost per procedure	Cost per year

Subtotal

Subtotal

Subtotal

Subtotal

Future Adjunctive Therapies
Therapy	Purpose	Frequency	Cost per month	Cost per year

Subtotal

Subtotal

Subtotal

Home Furnishings and Adaptations
Need	Purpose	Initial cost	Upkeep	Final cost

Subtotal

Subtotal

Financial Summary
Description	Cost per Year	Non-recurring cost
I. Future Medical Care - Routine
II. Future Medical Care - Specialty
III. Treatment Interventions
IV. Medication Needs
V. Supplies
VI. Diagnostic Testing
VII. Future Adjunctive Therapies
VIII. Medical Equipment
IX. Transportation
X. Home Furnishings and Adaptations
XI. Potential complications
TOTAL:

V. REFLECTION AND CONCLUSION