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Your Discharge Planning Checklist brochure - Medicare

1 Your Discharge Planning Checklist :For patients and their caregivers preparing to leave a hospital, nursing home, or other care settingName:Reason for admission: 2 During your stay, your doctor and the staff will work with you to plan for your Discharge . You and your caregiver (a family member or friend who may be helping you) are important members of the Planning team. You and your caregiver can use this Checklist to prepare for your : Use this Checklist early and often during your stay. Talk to your doctor and the staff (like a Discharge planner, social worker, or nurse) about the items on this Checklist . Check the box next to each item when you and your caregiver complete it. Use the notes column to write down important information (like names and phone numbers). Skip any items that don t apply to items Care after Discharge Ask where you ll get care after you re discharged.

• Bathing, dressing, using the bathroom, climbing stairs • Cooking, food shopping, house cleaning, paying bills • Getting to doctors’ appointments, picking up prescription drugs Have support in place that can help you. See “Resources” on page 6 for more information. Ask the staff to show you and your caregiver any

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