Hospice/End-of-Life Discharge Summary
Patient Information
Patient Name
Date of Birth
MRN/ID
Date of Admission
Date of Discharge/Death
Referring Physician
Primary Diagnosis
Secondary Diagnoses / Significant Comorbidities
Reason for Discharge
Course Summary
Goals of Care
Clinical Interventions
Medications at Discharge
Palliative Symptoms and Management
Disposition & Follow-up Plan
Family/Caregiver Education
Additional Notes
Completed by
Date