Stroke Patient Post-Discharge Follow-up Log
Patient Name
MRN / ID
Date of Birth
Date of Discharge
Date of Follow-up
Contact Method
Phone
In-person
Video
Other
Functional Status / Symptoms (mobility, speech, swallowing, cognition, etc.)
Medication Adherence & Changes
Rehabilitation Progress / Needs (PT/OT/SLP, etc.)
Complications / Issues Noted (falls, readmissions, pressure ulcers, etc.)
Social Support / Caregiver Status
Plan / Recommendations / Referrals