Hospital number | Past medical history | Documented if from nursing or residential home | New medications | Is follow-up required | Did acute kidney injury occur | Diagnosis of delirium during admission |
Ward | Concise summary of admission | Changes to functional status documented | If so: name, dose and timing | If so: included in summary | If so: stage documented | If so: recorded on summary |
Consultant | Relevant tests and results | | If so: indication | General practitioner action required | If so: post-discharge monitoring | Pre-existing diagnosis of dementia |
Age | List of diagnoses clearly stated | | Medications stopped | If so: clear instructions | | If so: recorded on summary |
Sex | | | If so: name | Information in lay terminology | | |
Admission date | | | If so: indication | | | |
Discharge date | | | Dose changes | | | |
Grade of clinician writing summary | | | If so: included | | | |
Multiple authors | | | If so: indication | | | |
Prepared in advance | | | Allergy status updated | | | |