Document Code No.
CHS/BSN-CURR -RLEFORM-002c
Revision No.
Effective Date
Page No.
00
02.24.2023
1 of 2
DISCHARGE PLAN
Drug/s
Indication/s
Dosage
Route
Frequency
It refers to the use of that drug for
treating a particular disease.
The amount of a medicine or
drug that someone takes or
should take.
Classified by the location
at which the drug is
applied, such as oral or
intravenous.
It is the number of
medication is to be
administered.
Medication/s
Generic Name (Brand Name)
Activity requiring physical effort, carried out to sustain or improve health and fitness
Exercise
It is the attempted remediation of a health problem, usually following a medical diagnosis. As a rule, each therapy has indications and contraindications.
Therapy
Focuses on health promotion and disease prevention, educating and empowering people to avoid disease, to make lifestyle changes, and to improve health for
themselves, their families, the environment, and their community.
Health Teachings
Days will be determined by counting one visit day for each calendar day that a patient visits the outpatient department.
OPD Visit
It refers to the food and drink that is regularly consumed by an individual. During a particular therapy of a disease or management of a particular health
condition, the diet may be controlled one that meets the physical needs of an individual.
Diet
Spiritual
Involves the recognition of a feeling or sense or belief that there is something greater than myself, something more to being human than sensory experience, and
that the greater whole of which we are part is cosmic or divine in nature.
Document Code No.
CHS/BSN-CURR -RLEFORM-002c
Revision No.
Effective Date
Page No.
00
02.24.2023
2 of 2
It is a medical specialty that uses therapeutic lifestyle interventions as a primary modality to treat chronic conditions including, but not limited to, cardiovascular
diseases, type 2 diabetes, and obesity.
Lifestyle
A written order from your primary care doctor for you to see a specialist or get certain medical services.
Referral
EVALUATION TOOL: DISCHARGE PLAN RUBRIC
UNACCEPTABLE
1-3
SATISFACTORY
4-7
EXCEPTIONAL
8-10
REMARKS
Completeness Of
Transcribing Orders
Only few (75%) of the discharge orders were
transcribed
Some (75-99%) of the discharge orders were
transcribed
All (100%) of the discharge orders were
transcribed
Plans/Objectives
Objectives were not clearly stated. Teaching
methods used were not appropriate for the
type of materials, topics covered and learners
(according to age-group).
Some objectives were not clearly stated. Some
teaching methods used were not appropriate for
the type of materials, topics covered and learners
(according to age-group).
Interventions
Intervention/s are not appropriate for the
patient and does not promote wellness nor
improvement of the patient’s condition (<5
interventions)
Correct Intervention/s but lacking (5-8
interventions)
Health education plan was well written, and
objectives were clearly stated. Teaching Methods
used were appropriate for the type of materials,
topics covered and learners (according to agegroup).
Intervention/s (>8 interventions) are correct and
appropriate for the patient.
Total
___/10