DATE OF SERVICE:
DATE OF ADMISSION:
DATE OF DISCHARGE:
MOST RESPONSIBLE DIAGNOSIS:
PRE ADMIT COMORBIDITIES:
POST ADMIT COMORBIDITIES:
SECONDARY DIAGNOSIS:
PRINCIPAL PROCEDURE:
OTHER PROCEDURES:
DISCHARGE MEDICATIONS:
CLINICAL SUMMARY:
FOLLOW-UP PLAN/CARE:
Thank you for involving us in the care of this patient.
THANKS & SIGNOFF