Discharge Survey
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Discharge Survey
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The Discharge Survey gathers critical feedback from patients who are being discharged from a hospital, surgical center, or inpatient facility. The transition from inpatient to home care is one of the highest-risk moments in the patient journey, and understanding how well your discharge process prepares patients for self-management can directly reduce readmission rates. This template evaluates the clarity of discharge instructions, patient confidence in managing their condition at home, understanding of new medications, and awareness of warning signs that should prompt them to seek emergency care.
The survey covers the full discharge experience including how much advance notice the patient received, whether they felt rushed or had adequate time to ask questions, and whether a family member or caregiver was included in the discharge education. Patients rate the quality of written discharge instructions, their understanding of activity restrictions and dietary guidelines, wound care instructions if applicable, and the plan for follow-up appointments. A dedicated section assesses whether the patient knows whom to call if they have questions or concerns after leaving the facility.
Designed for hospitals, ambulatory surgery centers, rehabilitation facilities, and skilled nursing facilities, this survey supports compliance with CMS discharge planning requirements and HCAHPS survey domains. The data helps discharge planners, case managers, and nursing leadership identify where education gaps exist and implement targeted interventions to improve patient preparedness, reduce preventable readmissions, and strengthen the overall care transition process.
What's included
- Discharge instruction clarity and comprehension assessment
- Medication understanding and reconciliation verification
- Follow-up appointment and care plan awareness evaluation
- Warning sign education and emergency contact confirmation
- Caregiver involvement and home readiness assessment
- Overall discharge experience rating with open feedback
Who uses this template
- Hospitals reducing 30-day readmission rates through discharge feedback
- Ambulatory surgery centers evaluating post-operative discharge education
- Rehabilitation facilities assessing patient readiness for home transition
- Case managers identifying gaps in discharge planning processes
All form fields
12 fields across 2 pages. Customize any field after signing up.
How to use the Discharge Survey
Getting started with this template takes just a few minutes. Sign up for a free Formisoft trial, then select the Discharge Survey from the template library. The form is ready to use immediately, but you can customize every field, add your practice logo, and adjust the layout to match your workflow.
Setup steps
- 1Choose the template. Find the Discharge Survey in the template library and click “Use this template” to add it to your account.
- 2Customize fields. Add, remove, or reorder any of the 12 fields. Set fields as required or optional based on your practice needs.
- 3Brand it. Upload your logo, pick your colors, and add a custom welcome message so patients see your practice identity.
- 4Share with patients. Send the form via SMS, email, or embed it on your website. Patients complete it on any device before their visit.
- 5Review submissions. Responses appear in your dashboard in real time. Patient records are created automatically from the data collected.
Frequently asked questions
Is the Discharge Survey HIPAA compliant?
Yes. All Formisoft templates, including the Discharge Survey, are HIPAA compliant. Data is encrypted with 256-bit AES at rest and TLS 1.3 in transit. A Business Associate Agreement (BAA) is included on every plan.
Can I customize the fields in this template?
Absolutely. You can add, remove, reorder, or modify any of the 12 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.
How do patients fill out this form?
Patients receive a link via SMS, email, or QR code. They complete the form on their phone, tablet, or computer before their appointment. No app download required.
Can I send this form automatically before appointments?
Yes. Formisoft's workflow automation can send intake forms automatically when an appointment is booked. You can set the timing (e.g., 48 hours before the visit) and include reminders for patients who haven't completed it.
Does this template work on mobile devices?
Yes. The Discharge Survey is fully responsive and works on any device. Most patients complete intake forms on their phone, so every template is optimized for mobile-first use.
Start with this template
Sign up and start customizing the Discharge Survey for your practice. Set up in minutes.
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