Automated Physician’s Discharge Summary

The Crib Notes™ Discharge Summary is a special type of Progress Note that combines the admission summary and exam, problem-oriented summaries and structured diagnoses from physician progress notes.  In particular, it includes:

  • An edited version of the Admit Note as an introduction
  • The Hospital Course (including each problem area with data in summary sections, last relevant objective data, appraisals, and plans)
  • The current patient Physical Exam (formatted as the Discharge Exam)
  • Medications List
  • Procedure List (for those procedures flagged for inclusion)
  • Clinical Problems List with identified and resolved dates
  • Diagnoses List
  • Follow-Up Plans
  • Discharge Summary Recipients report

Discharge Summaries can be completed by the discharging doctor and given to the parents as well as faxed to the pediatrician upon patient discharge. This eliminates the need for lengthy discharge dictations, costly transcriptions, lengthy sign-off delays and trips to the Medical Records department to complete charts.