Discharge form from hospital 2026

1. Click ‘Get Form’ to open the discharge form in our editor.
2. Begin by filling in the 'Facility Name' and 'Federal Tax ID #' at the top of the form. Ensure accuracy as this information is crucial for identification.
3. Next, provide the 'Address', 'City, State, Zip Code', and 'Facility Contact' details along with their phone number. This helps in establishing communication regarding the discharge.
4. Fill in the member's personal information including 'Member’s Name', 'Birth date', and 'Member ID #'. This section is vital for patient identification.
5. Complete the admitting physician's details by entering their name and tax ID, followed by their address and contact information.
6. Indicate the admission date and relevant ICD 9 code. Specify whether it was an observation, acute inpatient, or other type of admission.
7. If applicable, provide any surgical procedure codes related to the admission.
8. Finally, fill out the discharge date and where the member is being discharged to. Review all entries for accuracy before saving or sending your completed form.

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