The Hospital Release Form is a critical document required by Indonesian healthcare regulations for documenting patient discharges from medical facilities. It serves as the formal record of a patient's transition from inpatient care to outpatient status or complete release from medical care. This document is mandatory under Indonesian Law No. 44 of 2009 on Hospitals and related healthcare regulations. The form includes essential information about the patient's treatment, current condition, discharge instructions, and any follow-up care requirements. It also serves as legal documentation protecting both the healthcare provider and patient by clearly stating the conditions of release and any associated risks or responsibilities. The form must be completed for all patient discharges, whether routine, against medical advice, or in cases of transfer to other facilities.
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1. Patient Information: Complete identification details of the patient including full name, medical record number, date of birth, and address
2. Hospital Information: Official hospital name, address, and department/unit details
3. Admission Details: Date of admission, primary diagnosis, and treatment received during hospitalization
4. Discharge Summary: Brief summary of the patient's condition at discharge, including vital signs and general status
5. Patient Acknowledgment: Statement confirming the patient understands the discharge instructions and associated risks
6. Financial Settlement: Confirmation that all hospital bills and financial obligations have been settled
7. Signatures: Dedicated space for signatures of patient/guardian, attending physician, and witness
1. Against Medical Advice Release: Additional acknowledgments and warnings when patient chooses to leave against medical advice
2. Special Care Instructions: Detailed post-discharge care requirements for complex cases or ongoing treatment needs
3. Transfer Information: Details of transfer arrangements if patient is being transferred to another facility
4. Guardian Authorization: Additional section when patient is a minor or unable to provide consent
5. Interpreter Confirmation: Required when form is explained through an interpreter for non-native language speakers
6. Follow-up Appointments: Schedule of follow-up visits and specialist consultations if required
1. Medication Schedule: Detailed list of prescribed medications, dosages, and administration schedule
2. Home Care Instructions: Specific instructions for self-care, wound care, or other medical procedures at home
3. Emergency Contact Information: List of hospital contacts and emergency numbers for post-discharge concerns
4. Activity Restrictions: Detailed list of restricted activities and duration of restrictions
5. Dietary Instructions: Specific dietary requirements and restrictions post-discharge
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Medical Services
Hospital Administration
Private Healthcare
Public Healthcare
Emergency Medical Services
Specialist Medical Services
Rehabilitation Services
Mental Health Services
Aged Care
Relevant Teams
Legal
Medical Administration
Patient Services
Risk Management
Quality Assurance
Medical Records
Compliance
Clinical Operations
Nursing Administration
Patient Care
Admissions
Relevant Roles
Hospital Administrator
Medical Director
Chief Medical Officer
Head of Nursing
Legal Compliance Officer
Risk Management Officer
Patient Services Manager
Medical Records Officer
Quality Assurance Manager
Healthcare Facility Manager
Admissions Officer
Discharge Planning Coordinator
Patient Care Coordinator
Clinical Documentation Specialist
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