Discharge Summary (Pediatric Oncology)

Patient Name: [Patient full name] MRN: [Medical record number] DOB: [MM/DD/YYYY] Caregiver/Guardian: [Primary caregiver/guardian name(s) and relationship]

Admission Date: [MM/DD/YYYY] Discharge Date: [MM/DD/YYYY] Discharging Service: [Service] Attending of Record: [Attending physician] Primary Oncologist: [Oncologist name] Disposition: [home / transfer facility / other]

Reason for Hospitalization

[Presenting problem and trigger for admission] (One to three sentences. If a scheduled chemotherapy admission, include protocol context with cycle/day and reason for inpatient monitoring.)

Oncology Background

• [Cancer diagnosis with histology, site, stage/risk group]
• [Date of diagnosis]
• [Current protocol/regimen name] (Use most specific known descriptor; do not guess if unknown.)
• [Cycle and day at admission]
• [Treatment intent: curative / maintenance / palliative]
• [Central line type] (Include only if pertinent to discharge safety.)
• [Relevant baseline risks or prior serious toxicities] (Include only if pertinent to discharge safety.)

Allergies

[Drug and non-drug allergies with reaction type and severity] (If none, state: No known drug allergies.)

Discharge Diagnoses

1. [Primary discharge diagnosis] [active / resolved / improving / chronic-stable]
2. [Secondary diagnosis] [status]
3. [Additional diagnoses as needed] [status] (Use confirmed diagnoses rather than symptoms when possible; label uncertain diagnoses as suspected or probable.)

Hospital Course

(Problem-oriented narrative organized by clinical priority. For each problem, briefly describe what happened, what was done, clinical response, and unresolved issues requiring follow-up. Address relevant domains as applicable: chemotherapy administration and tolerance, infectious issues and antimicrobials, cytopenias and transfusions, GI/nutrition, renal/electrolytes, pain and symptom management, procedures, and consultations. Omit domains with no relevant events. Summarize key lab trends rather than listing daily values.)

[Hospital course narrative]

Chemotherapy Administered This Admission

(This section is required. If no antineoplastic therapy was administered, state: No chemotherapy or antineoplastic therapy administered during this hospitalization.)

Protocol/Regimen: [Name] Cycle/Day: [Cycle X Day Y]

Agent (generic)	Dose (units; basis)	Route	Date given	Dose modifications (reason)
[Agent name]	[Dose; mg/m² or mg/kg; BSA or weight used]	[IV / PO / IT / other]	[MM/DD/YYYY]	[None / modification and rationale]
[Additional agents as needed]	[Dose details]	[Route]	[Date]	[Modification details]

Supportive Measures: [Hydration/uroprotection, rescue therapy, growth factor with start date, antiemetics] (List agent, dose, route, dates as applicable.)

Interpretive Note: [Therapy completed as planned / held / modified]; [Anticipated nadir window if relevant]; [Required post-discharge monitoring and responsible clinician]

Condition at Discharge

[Clinical stability statement: afebrile status, hemodynamics, oral tolerance, pain control]

Key Labs ([MM/DD/YYYY]): ANC [value], Hgb [value], Plt [value], Cr [value]; [Additional relevant values]

Central Line: [Type]; [functioning / concerns]; [dressing status]

Discharge Medications

(Reflect medication reconciliation. If no medications prescribed, state: No discharge medications prescribed.)

New or Changed Medications

• [Generic name] [dose] [route] [frequency]; Indication: [reason]; Duration: [stop date or criteria]; [PRN: trigger and max frequency if applicable]

Continued Home Medications

• [Generic name] [dose] [route] [frequency]; Indication: [reason]

Stopped Medications

• [Generic name]; Reason: [reason] (Include if safety-relevant.)

Follow-up Plan

• Appointments: [Date, time, location, provider, purpose] (List each scheduled appointment.)
• Lab monitoring: [Test(s), frequency, location, result routing]
• Next chemotherapy: [Planned date/window and prerequisites]
• If not yet scheduled: [Responsible party] to contact family within [timeframe]
• Home services: [Agency, start date, services] (If applicable.)

Pending Results

(This section is required. If none, state: No pending studies or results at discharge.)

• [Test name] — Collected: [MM/DD/YYYY]; Status: [preliminary / processing]; Expected: [timeframe]; Responsible: [clinician/team]; Plan if abnormal: [action]

Return Precautions

(This section is required regardless of current ANC.)

• Fever: Temperature ≥[program threshold]; Action: [call immediately / proceed to ED]; do not give antipyretics before calling.
• Urgent symptoms: chills/rigors, respiratory distress, new cough, new rash, altered mental status, line site tenderness/redness/drainage, uncontrolled vomiting, poor intake, decreased urine output.
• Bleeding precautions: epistaxis not stopping, hematemesis/melena, petechiae with other symptoms, head injury.
• Central line emergencies: leak, dislodgement, inability to flush, redness/swelling/drainage—clamp line and seek immediate help.
• Contacts: Daytime clinic: [phone]; After-hours: [on-call number]; Call 911 for severe respiratory distress, unresponsiveness, or seizure.

Communication and Handoff

• Discharge summary sent to: [Primary oncologist, PCP, home health/infusion, other]
• Discharge teaching completed with: [Caregiver name(s)]; Topics emphasized: [high-risk changes discussed]
• Prescriptions sent to: [Pharmacy name]

(Do not infer remission status, organism clearance, or chemotherapy completion without explicit documentation. Use explicit dates throughout. When information is unknown, assign responsibility and timeframe for resolution.)