Free printable · for anyone going into the hospital with somebody
One-Page Patient Summary
A one-page patient summary is the sheet you hand a new clinician on arrival — a hospital information sheet for somebody nobody in the building has met yet. Fill it in from memory in a waiting room and give a copy to the first nurse or admitting clerk you see.
Take it with you — free, no signup
Direct download. No email, no account — just the files.
What it does
- Who they are: why they are here, what they already live with, and what they are allergic to.
- Medicines taken at home: two columns — what it says on the box, and how much and when. No pharmacy spelling needed.
- Aids that get lost: glasses, a hearing aid, dentures, a cane, a walker.
- Getting around and being understood: how they move, how they hear and speak, and what an ordinary day looks like.
- Who decides, and who to call: the person who decides if they cannot, then first, second and third calls with the numbers.
- A worked example, pre-filled: one invented family, so you can see the level of detail before you write anything.
- Two ways to fill it: print it and write on it, or type into the same sheet and update it instead of re-writing it.
- A records sheet, not a clinical one: it holds what you write down, and states nothing clinical.
Related reading
- Hospital Discharge Checklist: What to Ask Before You Leave The questions this sheet is the front half of — what to ask before anyone goes home.
- How to Organize Medications for an Aging Parent How to build the home medicines list this sheet asks you to copy in.
- Caregiver Quick Sheet The fridge version, for the ordinary weeks rather than the hospital ones.
- What Is a Discharge Summary? The document the hospital writes when somebody leaves — and what it does not cover.
Own it, don't rent it
Want the sheet that tells you what changed?
This sheet is arrival. The kit is the rest of the week, and it does one thing this page deliberately does not: it compares. Its fillable working set takes 16 medicine rows across three columns — taken at home, given here, sent home on — and writes the fourth itself: New, Stopped, Dose changed or Unchanged for every one, with a count. It then writes the hand-over page for the pharmacy or the family doctor. A discharge readiness ledger of 18 items across 6 domains counts what is still open, while somebody is still there to ask. Around those: 26 print-and-carry pages in the order the days happen, 87 prompts to say out loud with a line to read back what you were told, 12 cut-out cards in 5 designs, 11 more sheets for surgery and rehab, a 35-page worked example, and a reference sheet of 9 cited statements from 6 named sources. 11 PDFs, 168 pages — the four you print and carry come in both US Letter and A4.
A one-time purchase you print for this stay and the next one. No seat, no subscription, and no account that stops working when you stop paying.
An organizing sheet, not medical advice. It records what you write down and what you are told; it contains no clinical guidance, no symptom lists, no thresholds and no dosing help. Ask the team caring for the person, and their own doctor and pharmacist, about anything clinical. Every person and number in the worked example is invented. A filled-in copy carries somebody's medical information — keep it as you would a bank statement, share it only with people who need it, and shred or delete it when you no longer need it.