Hospital Discharge Medication Checklist

Complete this before the first follow-up visit after a hospital or emergency-room stay.

Page 1 of 2

Patient nameDate updatedDoctor or clinicAppointment date

Before the appointment

Bring every medicine bottle and package.Bring the hospital discharge list.Mark medicines started or changed.Separate medicines that were stopped.Include nonprescription products.Write down new symptoms or concerns.

Medication changes 1–15

#	Medicine	Started	Stopped	Dose or directions changed
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Hospital Discharge Medication Checklist

Complete this before the first follow-up visit after a hospital or emergency-room stay.

Page 2 of 2

Patient nameDate updatedDoctor or clinicAppointment date

Medication changes 16–30

#	Medicine	Started	Stopped	Dose or directions changed
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

Ask before leaving the visit

Which list is now correct?What should be stopped or discarded?When is each medicine taken?What symptoms require a call?