What is the hospital discharge planning checklist form template?
When someone is about to leave hospital, a lot has to happen at once: a lift home, a frame or commode delivered, a bed moved downstairs, medicines collected, follow-ups booked and carers arranged. Usually it's spread across a family group chat. This checklist puts it in one place, filled in by the family member or carer doing the organising and saved as a dated PDF.
It starts with who is coming home, from which hospital and ward, whether a discharge date has been set and where they're going — their own home, family, a care home or a rehab unit. The getting-home page covers transport and a short list of things to have ready on arrival, such as keys, heating, food and a made-up bed.
The heart of the form is one grid, "Where are you with each of these?", which marks equipment, adaptations, a downstairs bed, medicines, appointments, care visits and informing the GP as sorted, in progress, not started or not needed. Medicine changes, a discharge letter upload, follow-ups, warning signs from the ward, care support and "Who is doing what?" complete the plan, and every version is kept in your FileIt vault.
- Best for
- Families, unpaid carers, care coordinators and support workers
- Filled in by
- The person organising the discharge
- Time to complete
- About 10 minutes
- Includes
- Readiness grid, equipment list, medicines notes, discharge letter upload, task list
Who uses a hospital discharge planning checklist form?
- A daughter plans her father's return home after a hip operation
- A family shares one discharge plan between siblings in different cities
- A carers' support charity gives the checklist to families on a hospital ward
- A care coordinator records what a family has arranged before a discharge meeting
- A partner tracks equipment deliveries and follow-up appointments after a stroke
- A family updates the checklist each time the discharge date moves
Questions on this hospital discharge planning checklist form
32 questions over 5 pages · includes file upload, conditional questions, multiple pages, consent checkbox, ratings.
1 Who & when
- Your name*
- Email*
- Phone*
- Name of the person coming home*
- Your relationship to them
- Hospital and ward*
- Ward phone number
- Has a discharge date been set?*
- Planned discharge date* asked only when it applies
- Expected time asked only when it applies
- Where are they going after hospital?* Their own home · Living with family · A care home · An intermediate or rehab unit
- Will they be living alone? asked only when it applies
2 Getting home
- How will they get home?* Family or friend driving · Taxi · Hospital transport · Not decided yet
- Who is collecting them? asked only when it applies
- Ready at home for arrival Keys available · Heating or cooling on · Food in the fridge · Bed made up · Clothes for the journey · Phone and charger
3 Home & equipment
- Where are you with each of these?* Sorted · In progress · Not started · Not needed
- Equipment they'll need at home Walking stick or frame · Wheelchair · Commode · Raised toilet seat · Shower chair · Hospital bed · Pressure-relief mattress · Hoist · Oxygen
- Who is supplying the equipment, and when will it arrive? asked only when it applies
- Are there stairs they'll need to manage?
- How will they manage the stairs? asked only when it applies
- Anything at home that needs sorting first?
4 Medicines & follow-up
- Have their medicines changed during this stay?*
- Has someone explained the changes to you or to them? asked only when it applies
- Notes on medicines
- Discharge letter or medicines list
- Follow-up appointments
- What did the ward say to look out for, and who to call?
5 Care & responsibilities
- Care or support at home* Not needed · Family will provide it · Paid carers arranged · Paid carers being arranged · Waiting for an assessment
- Who, how often and from when? asked only when it applies
- Who is doing what?
- Worries or questions to raise with the ward
- Sharing*
The hospital discharge planning checklist form, page by page
1 Who & when
The organiser's name, email and phone, the required "Name of the person coming home", their relationship, and the required hospital and ward. "Has a discharge date been set?" — a yes asks for the planned date and expected time. "Where are they going after hospital?" is required; choosing their own home asks whether they'll be living alone.
2 Getting home
The required "How will they get home?" — family or friend driving (which asks who is collecting them), taxi, hospital transport or not decided yet — and a checklist of things ready at home for arrival.
3 Home & equipment
The required grid "Where are you with each of these?" with seven rows from equipment delivered to GP informed, each marked sorted, in progress, not started or not needed. Then the equipment they'll need (ticking any asks who is supplying it and when), stairs and how they'll be managed, and anything at home that needs sorting first.
4 Medicines & follow-up
The required "Have their medicines changed during this stay?" — a yes asks whether someone has explained the changes. Then notes on medicines, an optional upload of up to three files for the discharge letter or medicines list, follow-up appointments, and "What did the ward say to look out for, and who to call?".
5 Care & responsibilities
The required "Care or support at home" choice — anything other than not needed asks who, how often and from when. Then "Who is doing what?", worries or questions to raise with the ward, and a required sharing consent.
Make the template yours
- Add rows to the readiness grid for things your family needs, such as a pet sitter or a blue badge
- Rename the equipment list to match what your local service supplies
- Add the names of family members as NotifyEmails so everyone gets each update
- Turn off "Allow multiple" if only one checklist should ever be filed
- File every version in a vault folder for the person coming home
- For a support service, add a page for the worker's notes
Tips for a better hospital discharge planning checklist form
- Start the checklist as soon as a discharge is mentioned, not on the day itself
- Fill it in again each time something changes — each submission is a dated PDF, so you keep the history
- Ask the ward for the discharge letter and upload a photo of it straight away
- Write down who to call if something goes wrong in the first few days
- Share the PDF with whoever is staying the first night
Every response becomes a PDF in your vault
Each checklist is saved as a PDF in your vault, titled with your name and the date, with the readiness grid printed as a table and any uploaded discharge letter filed as an attachment. Anyone on the notify list is emailed.
Because the form allows more than one response, you can submit an updated checklist as plans change and see every version in the Responses table, newest first.
- Start from this template. It opens in the FileIt Forms designer — change any question, add pages, set the rules for when questions appear.
- Share it. Turn on a public link, or send it to people by email, each with their own link. They don’t need a FileIt account.
- Get the answers as PDFs. Each response is saved as a PDF in the vault folder you choose, with uploaded files attached — and listed in a Responses table you can export to CSV.
Hospital discharge planning checklist form: frequently asked questions
Is this discharge checklist template free?
Yes. It's one of the starter templates in the FileIt Forms app on every account, and you can edit any question or row.
Who should fill it in?
The family member, friend or carer organising the return home. The person leaving hospital doesn't need to do anything.
Can several family members see the plan?
Add their addresses to the form's notification emails so each new checklist reaches them, or share the PDF from your vault.
Can I update it when the date changes?
Yes. Submit it again — each submission is saved as its own dated PDF, so earlier versions are kept.
Does it replace the hospital's own discharge plan?
No. It's a family organiser. Follow the instructions the ward gives you.
Do people need a FileIt account to fill it in?
No. Anyone with the link can fill it in.