Emergency room (medical)
Instruction on discharge
Location of medical emergency:

Patient Name:

Medical record number:

Account number:

Visit date:

Medical director:

Director:

Internet health care provider:

Diagnoses and treatment by:

Follow up instructions:

What are the follow-up instructions?

Follow-up Internet health care http://www.qureshiuniversity.com/healthcareworld.html

Follow-up primary care physician.

Document released on: