Elderly Care Post-Discharge Follow-up Record
Date of Follow-up
Time
Mode of Follow-up
Phone Call
Home Visit
Telehealth
Patient Name
Age
Gender
Male
Female
Other
Address
Contact Number
Emergency Contact
Discharge Diagnosis
Medications
Recent Symptoms/Complaints
Mobility/Activity Level
Vital Signs (if assessed)
Blood Pressure
Heart Rate
Temperature
SpO₂
Caregiver/Family Concerns
Follow-up Appointments
Referrals/Recommendations
Staff/Professional Name
Designation
Signature