Completion of Discharge Instructions (page 6)

(See sample at page 26).

Specific Instructions

  • Whenever a sexual assault patient is discharged from the hospital or transferred to an inpatient department, the Discharge Instructions should be completed and a copy should be given to the patient.
  • Legibly complete all sections of the Discharge Instructions and provide all relevant information. This information may be helpful to the patient and/or the provider of follow-up care.
  • Review all information recorded on the Discharge Instructions with the patient or responsible party during discharge.
  • In Section 1 of the Discharge Instructions be sure to explain to the patient that the tests s/he received will only tell whether s/he had the disease/condition prior to the assault and hospital visit. Explain that follow-up testing must be done to determine whether a disease/condition was contracted during the assault.
  • In Section 2 of the Discharge Instructions note the name and dose of any medications administered or prescribed. Emphasize the need to take and finish all medications as prescribed.
  • In Section 2 of the Discharge Instructions explain that medications were given prophylactically, and stress the need for follow-up care.
  • In Section 3 of the Discharge Instructions stress the need to refrain from sexual relations until follow-up care has been received.
  • In Section 3 of the Discharge Instructions be sure that the patient, patient’s representative or responsible party understands that s/he is responsible for scheduling follow-up care.
  • In Section 3 of the Discharge Instructions provide the telephone number of the sexual assault crisis services Hotline (See page 69 for Referral and Assistance information).
  • In Section 3 of the Discharge Instructions provide information regarding available sexual assault crisis services, even though the patient may choose to consult a private mental health provider, or no one.
  • In Section 3 of the Discharge Instructions legibly write instructions regarding testing for HIV, including the location and telephone number of an anonymous/confidential HIV counseling and testing facility in the patient’s area. (See Appendix G for listing of counseling and testing facilities). (See also page 58 for information regarding HIV testing of sexual assault patients).
  • In Section 3 of the Discharge Instructions legibly write any additional instructions or information, as appropriate use additional paper as needed, keeping a copy for the medical record and providing the patient with a copy.
  • In Section 3 of the Discharge Instructions note that the booklet, Information  for Victims of  Sexual Assault and Their Families, was given to the patient.
  • In Section 4 of the Discharge Instructions legibly complete all categories of information for the patient’s reference as follows:
    • Provide the facility name, the name of one provider/examiner the patient can contact with further questions/problems, and the telephone number s/he can use to make that contact;
    • Provide the name and telephone number of the local sexual assault crisis service program. (See Appendix D)
    • Provide the name, town or troop, and telephone number of the police officer who responded and/or took custody of evidence;
    • Provide any other contact names and numbers discussed with the patient;
    • Record the “Control Number” (see below) used to identify any collected evidence if the patient decides not to report the incident to the police at the time.

Control Number

  • Whenever a sexual assault patient is undecided about whether to report the assault to the police, a control number – in place of the patient’s name or medical record number –must be used on the external identification labels of the evidence containers (e.g., the Kit box and clothing bag(s)).
  • The step envelopes inside the Kit box and the small white clothing bags inside the large brown clothing bag should always be labeled with the patient’s name and other requested information even if the control number will be used on external identification labels.
  • Control Number specifications should be noted in Section 4 of the Discharge Instructions as follows:
    • The name of the health care facility, followed by a colon;
    • The patient’s initials, followed by a colon;
    • The six-digit discharge date;
    • Hospital Name: ABC: mm/dd/yy.
    • For example, if a patient named Anne Marie Smith had a kit completed at Hartford Hospital on July 17, 20013, the control number would be: HartfordHospital:AMS:07/17/13

Necessary Signatures

In Section 5 of the Discharge Instructions, after discussing the recorded information with the patient and providing an opportunity for the patient to read the form and to ask questions, if necessary, the following should be completed:

  • The patient or the patient’s representative (parent or guardian) should sign the form in the appropriate space provided;
  • The examiner completing the Discharge Instructions should sign the form in the appropriate space provided;
  • The date and time of discharge should be entered in the space provided.

Distribution of Discharge Instructions

 When the Discharge Instructions have been completed and all necessary signatures have been attached, distribute the copies as follows:

  • The yellow copy of the Discharge Instructions should be given to the patient. S/he should be advised to bring that copy to follow-up visits;
  • The white copy of the Discharge Instructions should be placed in the patient’s medical record.