Taking Care of Myself:

A Guide for When I Leave

the Hospital
This guide is adapted from Project Re-Engineered Discharge (RED), which was funded by AHRQ

and conducted by Brian Jack, M.D., and colleagues at Boston University Medical Center.

Additional tools for implementing Project RED are currently being developed.

To use this guide you should:

■ Talk with the hospital staff about each of the items that are listed

in the guide.

■ Take the completed guide home with you. It will help you to take

care of yourself when you go home.

■ Share the guide with your family members and others who want to

help you. The guide will help them know how to help take care of

you.

■ Bring the guide to all of your doctor appointments so the doctor

knows what you have been doing to care for yourself since you left

the hospital.
1

Taking Care of Myself:

A Guide for When I Leave the Hospital

When you leave the hospital, there are a lot of things you need to

do to take care of yourself. You need to see your doctor, take your

medicines, exercise, eat healthy foods, and know whom to call with

questions or problems. This guide helps you keep track of all the

things you need to do.

My name: ______________________________________________

When I’m leaving the hospital _____________________________

If I have questions or problems, I should call:

________________________________________________________

Phone number: __________________________________________

If I have a serious health problem, I should call:

________________________________________________________

Phone number: __________________________________________

Bring this plan to all your medical appointments.
What is my medical problem?

__________________________________________________________

__________________________________________________________

What are my medication allergies?

__________________________________________________________

__________________________________________________________

Where is my pharmacy?

__________________________________________________________

__________________________________________________________

What exercises are good for me?

__________________________________________________________

__________________________________________________________

What should I eat?

__________________________________________________________

__________________________________________________________

What activities or foods should I avoid?

__________________________________________________________

__________________________________________________________

2
What medicines do I need to take?

Each day, follow this schedule:

3

Morning Medicines

Medicine name Why am I taking How much How do I take

(generic and this medicine? do I take? this medicine?

name brand)

and amount
What medicines do I need to take?

Each day, follow this schedule:

4

Afternoon Medicines

Medicine name Why am I taking How much How do I take

(generic and this medicine? do I take? this medicine?

name brand)

and amount
What medicines do I need to take?

Each day, follow this schedule:

5

Evening Medicines

Medicine name Why am I taking How much How do I take

(generic and this medicine? do I take? this medicine?

name brand)

and amount
What medicines do I need to take?

Each day, follow this schedule:

6

Bedtime Medicines

Medicine name Why am I taking How much How do I take

(generic and this medicine? do I take? this medicine?

name brand)

and amount
Medicine How much How do I

name and do I take? take this

amount medicine?

If I need

medicine for

a headache

If I need

medicine to

stop smoking

If I need

medicine for

____________________

If I need

medicine for

____________________

If I need

medicine for

____________________

If I need

medicine for

____________________

If I need

medicine for

____________________

If I need

medicine for

____________________

What other medicines can I take?

7
When are my next appointments?

8

Day Date

Time

Doctor’s name Specialty

Address

Reason for appointment

Doctor’s phone number

Questions for my appointment

Check any of the boxes below and write notes to remember what to

discuss with your doctor.

I have questions about:

My medicines ___________________________________________

My test results ___________________________________________

My pain ________________________________________________

Feeling stressed __________________________________________

Other questions or concerns __________________________________

__________________________________________________________
9

Day Date

Time

Doctor’s name Specialty

Address

Reason for appointment

Doctor’s phone number

Questions for my appointment

Check any of the boxes below and write notes to remember what to

discuss with your doctor.

I have questions about:

My medicines ___________________________________________

My test results ___________________________________________

My pain ________________________________________________

Feeling stressed __________________________________________

Other questions or concerns __________________________________

__________________________________________________________

When are my next appointments?
10

Day Date

Time

Doctor’s name Specialty

Address

Reason for appointment

Doctor’s phone number

Questions for my appointment

Check any of the boxes below and write notes to remember what to

discuss with your doctor.

I have questions about:

My medicines ___________________________________________

My test results ___________________________________________

My pain ________________________________________________

Feeling stressed __________________________________________

Other questions or concerns __________________________________

__________________________________________________________

When are my next appointments?
11

Day Date

Time

Doctor’s name Specialty

Address

Reason for appointment

Doctor’s phone number

Questions for my appointment

Check any of the boxes below and write notes to remember what to

discuss with your doctor.

I have questions about:

My medicines ___________________________________________

My test results ___________________________________________

My pain ________________________________________________

Feeling stressed __________________________________________

Other questions or concerns __________________________________

__________________________________________________________

When are my next appointments?
12

Day Date

Time

Doctor’s name Specialty

Address

Reason for appointment

Doctor’s phone number

Questions for my appointment

Check any of the boxes below and write notes to remember what to

discuss with your doctor.

I have questions about:

My medicines ___________________________________________

My test results ___________________________________________

My pain ________________________________________________

Feeling stressed __________________________________________

Other questions or concerns __________________________________

__________________________________________________________

When are my next appointments?
Notes about my medical problem

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________
AHRQ Pub. No. 10-0059

April 2010

www.ahrq.gov