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1. Patient Information: Complete identification details of the patient including name, age, gender, address, admission ID, and contact information
2. Hospital Information: Details of the hospital, including name, address, registration number, and treating physician details
3. Admission Summary: Brief overview of admission date, reason for admission, and primary diagnosis
4. Treatment Summary: Overview of treatments, procedures, and care provided during hospitalization
5. Discharge Status: Current medical condition and reason for discharge
6. Post-Discharge Instructions: Detailed instructions for medication, follow-up visits, diet, and activity restrictions
7. Financial Settlement: Confirmation of payment status and any pending financial obligations
8. Release Declaration: Legal statement confirming voluntary discharge and understanding of risks
9. Signatures: Space for signatures of patient/guardian, treating physician, and witness
1. Against Medical Advice Release: Additional declarations and warnings when patient is leaving against medical advice
2. Mental Health Addendum: Additional sections required for mental health patients as per Mental Healthcare Act, 2017
3. Special Treatment Declaration: For cases involving experimental or high-risk treatments
4. Translation Declaration: When form contents have been translated for non-English/local language speaking patients
5. Emergency Contact Authorization: Additional contact permissions for post-discharge emergencies
6. Insurance Documentation: Special declarations required by insurance providers
1. Schedule A - Detailed Medical Report: Comprehensive medical report including all diagnoses, procedures, and treatments
2. Schedule B - Medication List: Detailed list of prescribed medications, dosages, and administration instructions
3. Schedule C - Follow-up Schedule: Detailed calendar of follow-up appointments and required check-ups
4. Appendix 1 - Patient Rights: Statement of patient rights and responsibilities as per Indian law
5. Appendix 2 - Emergency Protocols: Emergency contact procedures and warning signs requiring immediate medical attention
Patient
Treating Physician
Legal Guardian
Medical Record
Discharge
Discharge Against Medical Advice (DAMA)
Treatment
Post-Discharge Care
Follow-up Care
Medical Emergency
Authorized Representative
Personal Effects
Medical Instructions
Prescription Medications
Healthcare Provider
Insurance Provider
Admission
Hospitalization Period
Medical Procedure
Witness
Consent
Release
Liability
Medical Advice
Clinical Summary
Hospital Premises
Medical Certificate
Treatment Plan
Patient Rights
Medical Status
Treatment Summary
Discharge Authorization
Patient Acknowledgment
Medical Instructions
Follow-up Care
Financial Settlement
Release of Liability
Confidentiality
Property Release
Emergency Protocol
Insurance Documentation
Patient Rights
Medical Records
Witness Requirements
Risk Acknowledgment
Consent
Dispute Resolution
Governing Law
Force Majeure
Severability
Amendment
Notices
Indemnification
Healthcare
Medical Services
Hospital Administration
Insurance
Legal Services
Mental Healthcare
Emergency Services
Rehabilitation Services
Public Health
Healthcare Education
Legal
Compliance
Medical Records
Patient Services
Quality Assurance
Nursing Administration
Risk Management
Medical Administration
Patient Relations
Documentation
Hospital Administrator
Medical Director
Chief Medical Officer
Head of Legal
Compliance Officer
Risk Management Officer
Medical Records Manager
Patient Services Manager
Quality Assurance Manager
Nursing Supervisor
Admissions Manager
Discharge Planning Coordinator
Healthcare Lawyer
Medical Documentation Specialist
Patient Relations Officer
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