Major Hospital

Patient Discharge Information

Congestive Heart Failure

Patient/Family Member received written Discharge Information for Congestive

Failure covering the following:

* Keep your scheduled follow-up appointments with your doctor. 

* When to call the doctor (trouble breathing, swelling, more tired, rapid weight gain)

* Diet

*Activity

* Medications

* Depression

* Tracking your weight

Information given via Krames On Demand written Health Sheets.

Signed: Patient Name_____________________________________Date______________________

              Other:______________________________ Relationship___________________________

Nurse: ___________________________________ Date__________________________________

*** Place this signed copy (of this sheet only) in chart under CONSENTS***