Using this easy-to-read guide with patients during discharge can help them care for themselves when they leave the hospital to track their medication schedules, upcoming medical appointments, and important phone numbers.
Contents
Using the Guide
Taking Care of Myself: A Guide for When I Leave the Hospital
Â鶹´«Ã½ the Guide
Using the Guide
Taking Care of Myself: A Guide for When I Leave the Hospital is a guide that providers can use to give patients the information they need to help them care for themselves when they leave the hospital.
How to use the fill-able PDF file:
Note: Some Web browsers may not allow you to fill in the blanks in this PDF file. To add your personal information to the guide, you may have to save the file to your computer and open it in Adobe Acrobat or Acrobat Reader.
To save your additions, you have to use Adobe Acrobat. Follow these steps:
- Download Taking Care of Myself: A Guide for When I Leave the Hospital (PDF, 776 KB) and save it to your computer.
- Open the file using Adobe Acrobat and type your information in the spaces provided.
- Save the completed file to your computer.
- Print the file, if desired.
You can view and add information to the file using Acrobat Reader, but you will not be able to save your additions. Follow these steps:
- Download Taking Care of Myself: A Guide for When I Leave the Hospital (PDF, 776 KB) and save it to your computer.
- Open the file using Adobe Reader and type your information in the spaces provided.
- Print the file.
Note: You will not be able to save any changes made to the PDF file.
Hospital staff use:
- Download Taking Care of Myself: A Guide for When I Leave the Hospital (PDF, 776 KB) to your computer and complete all of the information in the guide (except patient question sections).
- Talk with patients about the information in the guide.
- Confirm that patients understand instructions by asking patients to describe, in their own words, what they will do when they leave the hospital (e.g., when and how they will take their medicine, when they will go to their doctor's office).
- Give the patient a copy of the completed guide to take home and instruct them to take it to future medical appointments.
Patient use:
- Become familiar with the information covered in the guide before you enter the hospital.
- Make sure that the information about you in the guide is correct (e.g. medication allergies, contact information, primary care provider information).
- Study the guide with your clinicians to make sure you or your family members understand everything that is in it and how to care for yourself when you get home.
- Take the guide to your future medical appointments.
For other consumer and patient materials, go to the AHRQ Web site.
Taking Care of Myself: A Guide for When I Leave the Hospital
To use this guide you should:
- Talk with the hospital staff about each of the items that are listed in the guide.
- Take the completed guide home with you. It will help you to take care of yourself when you go home.
- Share the guide with your family members and others who want to help you. The guide will help them know how to help take care of you.
- Bring the guide to all of your doctor appointments so the doctor knows what you have been doing to care for yourself since you left the hospital.
When you leave the hospital, there are a lot of things you need to do to take care of yourself. You need to see your doctor, take your medicines, exercise, eat healthy foods, and know whom to call with questions or problems. This guide helps you keep track of all the things you need to do.
|
My name: _______________________________________________ Bring this plan to all your medical appointments. |
What is my medical problem?
______________________________________________________________________________
______________________________________________________________________________
What are my medication allergies?
______________________________________________________________________________
______________________________________________________________________________
Where is my pharmacy?
______________________________________________________________________________
______________________________________________________________________________
What exercises are good for me?
______________________________________________________________________________
______________________________________________________________________________
What should I eat?
______________________________________________________________________________
______________________________________________________________________________
What activities or foods should I avoid?
______________________________________________________________________________
______________________________________________________________________________
What medicines do I need to take?
Each day, follow this schedule:
Morning Medicines
| Medicines name (generic and name brand and amount) | Why am I taking this medicine? | How much do I take? |
How do I take this medicine? |
|---|---|---|---|
Afternoon Medicines
| Medicines name (generic and name brand and amount) | Why am I taking this medicine? | How much do I take? | How do I take this medicine? |
|---|---|---|---|
Evening Medicines
| Medicines name (generic and name brand and amount) | Why am I taking this medicine? | How much do I take? | How do I take this medicine? |
|---|---|---|---|
Bedtime Medicines
| Medicines name (generic and name brand and amount) | Why am I taking this medicine? | How much do I take? | How do I take this medicine? |
|---|---|---|---|
What other medicines can I take?
| Medication name and amount |
How much do I take? |
How do I take this medicine? | |
|---|---|---|---|
| If I need medicine for a headache | |||
| If I need medicine to stop smoking | |||
| If I need medicine for ______________ |
|||
| If I need medicine for _____________ |
|||
| If I need medicine for _____________ |
|||
| If I need medicine for _____________ |
|||
| If I need medicine for _____________ |
|||
| If I need medicine for _____________ |
When are my next appointments?
| Day ____________ | Date ____________ |
| Time _____________________ | |
| Doctor's name ______________ | Specialty ____________________ |
| Address _____________________________________________________________ ____________________________________________________________________ |
|
| Reason for appointment ___________________________________________________ | |
| Doctor's phone number ____________________________________________ | |
Questions for my appointment
Check any of the boxes below and write notes to remember what to discuss with your doctor.
I have questions about:
___ My medicines ________________________________________________
___ My test results ________________________________________________
___ My pain _____________________________________________________
___ Feeling stressed _____________________________________________
Other questions or concerns ________________________________________
___________________________________________________________
When are my next appointments?
| Day ____________ | Date ____________ |
| Time _____________________ | |
| Doctor's name ______________ | Specialty ____________________ |
| Address _____________________________________________________________ ____________________________________________________________________ |
|
| Reason for appointment ___________________________________________________ | |
| Doctor's phone number ____________________________________________ | |
Questions for my appointment
Check any of the boxes below and write notes to remember what to discuss with your doctor.
I have questions about:
___ My medicines ________________________________________________
___ My test results ________________________________________________
___ My pain _____________________________________________________
___ Feeling stressed _____________________________________________
___ Other questions or concerns ____________________________________
__________________________________________________________
When are my next appointments?
| Day ____________ | Date ____________ |
| Time _____________________ | |
| Doctor's name ______________ | Specialty ____________________ |
| Address _____________________________________________________________ ____________________________________________________________________ |
|
| Reason for appointment ___________________________________________________ | |
| Doctor's phone number ____________________________________________ | |
Questions for my appointment
Check any of the boxes below and write notes to remember what to discuss with your doctor.
I have questions about:
___ My medicines ________________________________________________
___ My test results ________________________________________________
___ My pain _____________________________________________________
___ Feeling stressed _____________________________________________
___ Other questions or concerns ____________________________________
__________________________________________________________
When are my next appointments?
| Day ____________ | Date ____________ |
| Time _____________________ | |
| Doctor's name ______________ | Specialty ____________________ |
| Address _____________________________________________________________ ____________________________________________________________________ |
|
| Reason for appointment ___________________________________________________ | |
| Doctor's phone number ____________________________________________ | |
Questions for my appointment
Check any of the boxes below and write notes to remember what to discuss with your doctor.
I have questions about:
___ My medicines ________________________________________________
___ My test results ________________________________________________
___ My pain _____________________________________________________
___ Feeling stressed _____________________________________________
___ Other questions or concerns ____________________________________
__________________________________________________________
When are my next appointments?
| Day ____________ | Date ____________ |
| Time _____________________ | |
| Doctor's name ______________ | Specialty ____________________ |
| Address _____________________________________________________________ ____________________________________________________________________ |
|
| Reason for appointment ___________________________________________________ | |
| Doctor's phone number ____________________________________________ | |
Questions for my appointment
Check any of the boxes below and write notes to remember what to discuss with your doctor.
I have questions about:
___ My medicines ________________________________________________
___ My test results ________________________________________________
___ My pain _____________________________________________________
___ Feeling stressed _____________________________________________
___ Other questions or concerns ____________________________________
__________________________________________________________
Notes about my medical problem
Â鶹´«Ã½ the Guide
Taking Care of Myself: A Guide for When I Leave the Hospital is adapted from the Project RED (Re-Engineered Discharge), which was funded by the Agency for Healthcare Research and Quality and the National Heart, Lung, and Blood Institute and operated by the Boston University Medical Center. Project RED showed that preparing patients to care for themselves when they leave the hospital can improve patient safety and reduce re-hospitalization rates. Giving patients an easy-to-understand discharge plan is 1 of 11 elements in the RED process.
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