Cardiac Rehabilitation Post-Discharge Follow-up Sheet
Patient Information
Name
Medical Record Number
Date of Birth
Contact Number
Date of Discharge
Diagnosis/Procedure
Diagnosis
Procedure
Follow-up Assessment
Date of Follow-up
Symptoms Since Discharge
Physical Activity Level
Medication Adherence
Vital Signs
Blood Pressure
Heart Rate
Weight
Issues Identified
Clinical Concerns
Barriers to Rehabilitation
Social Support
Plan/Recommendations
Rehabilitation Program/Advice
Medication Changes
Referrals
Next Follow-up
Date
Remarks
Healthcare Provider
Date