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Heart Failure Discharge Summary Checklist Mobile App

The Heart Failure Discharge Summary Checklist mobile app provides a simple way to generate a patient discharge form using a smartphone or tablet. This handy hospital discharge form for heart failure patients can help reduce readmission rates by providing clear, useful instructions for patients to follow.

The post-discharge app covers specific discharge instructions, including medications prescribed, counseling measures, follow-up scheduling and any other specific details that are needed. The information in the discharge plan can be emailed to the patient and saved electronically to their hospital records.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Heart Failure Discharge Summary Checklist Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico statictext

    Hospitalized Heart Failure Patients

  • Ico textbox

    Patient Name

  • Ico date

    Discharge Date

  • Ico checkbox

    Follow-up appointment scheduled?

  • Ico date

    Date

  • Ico time

    Time

  • Ico textbox

    Name of Provider

  • Ico textbox

    Location

  • Ico multiline

    If No, Reason

  • Ico multiline

    Brief medical history/discharge diagnosis

  • Ico textbox

    Ejection fraction at discharge

  • Ico statictext

    Method:

  • Ico checkbox

    Echocardiogram

  • Ico checkbox

    Cardiac catheterization

  • Ico checkbox

    MUGA scan

  • Ico textbox

    Name of provider completing this form:

  • Ico dropdown

    Were the following discharge medications prescribed?

  • Ico checkbox

    Yes

  • Ico checkbox

    No

  • Ico checkbox

    Not Indicated

  • Ico textbox

    Agent Prescribed

  • Ico dropdown

    Contraindication

  • Ico multiline

    Comments/ Reasons for Not Prescribing

  • Ico textbox

    Initials

  • Ico dropdown

    Were the following interventions and counseling measures addressed?

  • Ico checkbox

    Yes

  • Ico checkbox

    No

  • Ico checkbox

    NA

  • ...and More!

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