Hospital Discharge

Discharge DAP note with medication reconciliation

Consultation Date

Discharge Date

Patient Name

Date of Birth

Hospital Name

D Data

Medication Reconciliation

New Medications

Changed Medications

Stopped Medications

Clinical Connect Review

Admitting Diagnosis / Reason for Admission

Important Labs

Additional Relevant Information

A Assessment

Your clinical interpretation of the discharge information.

P Plan

Specific actions — include timeframes where relevant.

Plan Details

Counseled patient/agent on action, administration, and adverse effects of new medications

Reviewed med rec with patient — which medications are new, changed, and stopped

Follow-up required

Adherence aids offered / provided

Delivery method arranged

Signed by (Pharmacist)

Generated Note