THE COLLEGE OF MAASIN

Nisi Dominus Frustra

Tunga-Tunga, Maasin City, Southern Leyte, Philippines

PATIENT’S NAME: ______________________ AGE: __ MARITAL STATUS: _______

DIAGNOSIS: _________________________________________________________

DISCHARGED INSTRUCTION PLAN

S Subjective Cues

O Objective Cues

M Medications (include definite instructions)

E Environmental Modifications

T Treatment (non-pharmacological treatment)

H Health Teachings

O Observable signs/symptoms (cues for seeking prompt management)

D Diet Modifications

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