The Patient At Home Medication & Dosage List

The Patient At Home Medication and Diagnosis List form was developed for you to let us know just what medications you take at home, your allergies and the names and phone numbers of your Physician and Pharmacy. We request that you fill this form out completely and as legibly as possible and bring it with you to the hospital on the day of your surgery/procedure and present it to the admitting nurse.   


Preparing For Your Discharge

  • Be sure you are clear about discharge instructions, including medicines you need and information about a follow-up visit and continued care. Make sure you are given a phone number to call if you have questions.
  • We ask that you arrange (with a family member or friend) to leave the Medical Center before 11:00 am on the day of discharge, unless otherwise specified by your physician. If your physician extends your visit, please plan to leave as soon as your doctor writes your discharge order allowing you to leave the Medical Center.
  • Please ensure that you schedule a follow up visit with your physician prior to discharge.


Continuing Safe Practices at Home

  • Talk with your doctors and pharmacist. Ask questions and write down what they say.
  • Carefully check all prescriptions before taking them.
  • You can get bedside rails to use in your home if you need them.
  • Keep a phone or a bell near your bed if you might need help.
  • Never smoke in bed.
  • Be very cautious if you have oxygen equipment at home. There should be nosmoking around oxygen equipment as it is highly flammable.
  • If you have medical equipment that needs to be plugged in, use a grounded or three- prong connector. Do not use extension cords.
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