2008 December - Note 7

Precautions in discharging a patient

  • Only a duly qualified doctor must issue and sign all discharge orders.
  • Release minors/incompetents -
    • Only to parents or authorized guardian
    • Take proper acknowledgment in writing
  • Don’t detain patient, not even for non payment of fees.
  • Don’t discharge patients with notified communicable diseases.

Discharge card/Summary/Ticket

  • Discharge card/ticket must be prepared in duplicate. The patient must be given the original copy only after taking proper acknowledgment of receipt on the other copy which must be properly preserved in the medical records of the patient.
  • Only a duly qualified doctor must sign discharge card/summary/ticket.
  • It is not necessary to record full details of surgery.
  • It must briefly record
    • History
    • Diagnosis
    • Treatment
    • Post discharge care
    • Precautions
    • Risks
    • Warnings
    • Reason(s) for discharge
    • Follow-up schedules
    • Complications that may arise immediately or in due course and their redressal, if any

Discharge against medical advice

  • In case the patient is serious and discharge is sought against medical advice, specifically explain and record the consequences that may ensue after discharge or in transit.
  • Request for discharge against medical advice should only be considered if it is made by the patient or attendants in writing.
  • Elaborately and carefully record – discharge against medical advice form. Preserve it with utmost care.
  • Prepare a normal discharge card. Add the reason for which discharge is sought.
  • In case of discharge against medical advice, the legal responsibility of the hospital to transfer the patient to another facility ceases, though on ethical and moral grounds necessary help must be provided. Duly record these facts.

Discharge card even after death of patient?

Issue discharge card, even after death of patient. Andhra Pradesh State Consumer Commission has held way back in 2002 in the case of Mrs. Vijayamma and Ors. v/s Apollo Diagnostic Centre and Ors. that not issuing discharge card after death is negligence. Till the time this law is challenged by someone and set aside it is a good law and must be followed by every doctor.

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