Post-Hospital Discharge Transition of Care Form

Streamline Post-Hospital Care Transitions with Paperform

When patients leave the hospital, the transition back to home or outpatient care is a critical window where things can go wrong. Miscommunication about medications, missed follow-up appointments, and unrecognized warning signs are leading causes of hospital readmissions. This Post-Hospital Discharge Transition of Care Form template helps healthcare providers, primary care physicians, home health agencies, and care coordinators ensure nothing falls through the cracks.

Built specifically for the post-discharge period, this form captures essential information including discharge diagnosis, medication reconciliation, follow-up care instructions, mobility and support needs, and red flag symptoms that require immediate attention. It creates a clear, structured handoff between hospital teams and the providers or family members taking over care.

Why Paperform for Healthcare Transitions?

Paperform's conditional logic means you can adapt the form to different discharge scenarios—showing additional fields for patients with complex medication regimens, home health needs, or specific diagnoses. The doc-style editor makes it easy to include clear instructions, educational content about warning signs, and branded reassurance that helps anxious patients and caregivers feel supported.

Automate your care coordination by connecting this form to your workflow tools via Stepper. Automatically notify care teams when a discharge form is submitted, create follow-up appointment reminders, flag high-risk patients for early outreach, and sync patient information with your EHR or care management platform—all without manual data entry.

For home health agencies, primary care practices, hospital case management teams, care coordinators, and accountable care organizations, Paperform provides the SOC 2 Type II compliance and security controls you need, while giving non-technical staff the autonomy to update forms as care protocols evolve.

Better discharge planning reduces readmissions, improves patient satisfaction, and ensures continuity of care during one of the most vulnerable moments in the patient journey. This template is your starting point for building a reliable, compliant transition of care process that works for your team and your patients.