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FROM : ST. JOE GAS & BAIT FAX N0. 12185687272 Jun. 04 2006 08:04PM P6 <br /> IMPORTANT: Please bring this sheet and ALL medications in the appropriate bottle to the clinic on your first follow up <br /> with yoyr physician after discharde from the hospital. <br /> Admitted: -� Discharged: `f FOLLOW-UP VISIT: <br /> Diagnosis: _ �- G�•t Q'9 �') Clinic appointment pith Dr. <br /> ��, 7�7� rr %��-• ' .C'�?-��1 Z� Lab work or special instructions: <br /> ALLERGIES ;-'.• -,. 7'�. �.� C��•./?�v <br /> DIET: ' <br /> Type �, J <br /> Instruction given: - <br /> HEALTH TEACH z� <br /> MEDICATIONS: ' ` fry <br /> Brought in: Yes/No Returned by: r��,, <br /> al�js <br /> ENVIRONMENT: Discharged home with referral to: <br /> Home Health Care <br /> Public Health: <br /> "Ze-- <br /> A Social Services: <br /> S 0� Other: <br /> NOTIFY IN CASE OF EMERGENCY: <br /> AMBULANCE: 546-7070 <br /> CLINIC:• 548-8375 <br /> HOSPITAL: 546-7000. <br /> I understand the above`'rist'uctions and have received a c, <br /> 1 <br /> Discharge Nurse: 7' ' /- <br /> C--Patient or Reps <br /> r <br /> %,U:r'CJNAIEGIONAL ` �`'�:`��4e. <br /> lj(Jlr � <br /> MD�C MM <br /> I CROSBY.MINNESOTA 56441 <br /> I <br /> PATIENT DISCHARGE PLAN PATIENT COPY. <br />