If you have any questions about this admission, please contact Attending Physician at Discharge: Resident Physician: Nguyen Pager: 5042682688
Primary Care Physician/Provider: none
Admission Date: Jul ,2022 Discharge Date: Jul ,2022
PRINCIPAL DIAGNOSIS: SECONDARY DIAGNOSES: REASON FOR ADMISSION:
BRIEF HOSPITAL COURSE: No complication during surgery. Upon discharge, patient is ambulating, tolerating po, pain is controlled with po meds.
PROCEDURES: (List procedures performed during hospitalization. NO ABBREVIATIONS please)
ISSUES REQUIRING FOLLOW UP: a. CLINICAL ISSUES REQUIRING PCP FOLLOWUP: none
b. LABS OR TESTS PENDING AT DISCHARGE: none
c. SOCIAL ISSUES REQUIRING FOLLOWUP: none
d. APPOINTMENTS NEEDED BUT NOT YET SCHEDULED: none
PENDING APPOINTMENTS at SLVHCS: Future Appointments -
PENDING NON VA APPOINTMENTS: none
KEY FINDINGS & TEST RESULTS:
MEDICATIONS ON DISCHARGE: a. NEW MEDICATIONS: tramadol colace bactrim
b. DISCONTINUED OUTPATIENT MEDICATIONS: none
c. CHANGED OUTPATIENT MEDICATIONS: none
d. OTHER MEDICATIONS: none
e. ACTIVE OUTPATIENT MEDICATION LIST: Active Outpatient Medications (excluding Supplies): |ACTIVE MEDICATIONS|
DIET: regular
PHYSICAL ACTIVITY (LIMITATIONS) INSTRUCTIONS: no lifting heavier than 10 lbs for 6 weeks. no driving on narcotics.
POST-PROCEDURE AND OTHER DISCHARGE INSTRUCTIONS: If you have fever >101.5F, persistent nausea, vomiting, intractable pain, inability to urinate, please go to the ER for evaluation.
CONDITION AT DISCHARGE: Stable a. PERTINENT PHYSICAL FINDINGS: none
b. FUNCTIONAL STATUS: Ambulation: Independent ADL- Activities of Daily Living:Independent none
DISCHARGE DESTINATION: home
Time spent planning this discharge including discussion of hospital safety, instructions for ongoing care with all relevant caregivers, preparations of discharge documents, writing of discharge orders, and final examination of the patient.: 30 Minutes.