Nmhaacqsp3 Policy & Procedure For Discharge of Patient Including MLC & Absconded Cases

NARAYAN MEMORIAL HOSPITAL Document No.
(A UNIT OF NARAYAN HEALTH SERVICES PVT. LTD.) NMH/AAC/QSP/3
POLICY & PROCEDURE FOR DISCHARGE OF PATIENT INCLUDING

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MLC & ABSCONDED CASES
POLICY & PROCEDURE FOR DISCHARGE OF

PATIENT INCLUDING MLC & ABSCONDED CASES
NARAYAN MEMORIAL HOSPITAL

(A UNIT OF NARAYAN HEALTH SERVICES PVT. LTD.)
Behala Manton, 85, (Mail – 601), Diamond Harbour Road, Kolkata- 700034, West Bengal
Issue No: 01 Version No: 1

QUALITY SYSTEM PROCEDURE
Issue Date: 15.11.2023 Revision Date: NA

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DOCUMENT SUMMARY
Policy & procedure for discharge of patient including
Document Title
MLC & absconded cases
Document No. NMH/AAC/QSP/3
Current Version No. 1
Implementation Date 15.11.2023
Department Emergency, Nursing, Security, Operations
Document Storage Location Emergency, Nursing, Basement, Front office &
Quality Assurance
DOCUMENT DISTRIBUTION
Sl No. Name Designation Department
Consultant & Head – Emergency
1 Dr. Sudip Chakraborty Emergency
Medicine
2 Ms. Lipika Roy Nursing Director Nursing
3 Mr. Ujjal Patra Fire & Security In-charge Safety & Security
4 Moumita Ganguly Bose IPD Incharge IPD
DOCUMENT REVISION HISTORY

Sl No. Version No. Date of Amendment Page No. Clause No. Amendment Details
NA NA NA NA NA NA
DOCUMENT AUTHOR(S)
Version No. Name Designation Signature Date
Dr. Sneha Priya
1 Medical Superintendent 15.11.2023
Chowdhury
DOCUMENT REVIEWER(S)
Dr. Sneha Priya
Chowdhury
DOCUMENT APPROVER(S)
Dr. Sneha Priya
Chowdhury
DOCUMENT ISSUE
Issue No. Name Designation Signature Date
1 Ms. Subhasree Ghosh Executive- Quality Assurance 15.11.2023


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TABLE OF CONTENT
PAGE
SL. NO. TITLE
NO.
1 POLICY & PROCEDURE FOR DISCHARGE OF PATIENT INCLUDING MLC 4
2 POLICY & PROCEDURES FOR ABSCONDED CASES 8
3 LIST OF DOCUMENTS 10
4 REFERENCES 10
5 ABBREVIATION 10


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1. POLICY & PROCEDURE FOR DISCHARGE OF PATIENT INCLUDING MLC
1. POLICY
 A complete discharge summary is given to all the patients who are discharged from the hospital
including MLC and LAMA cases.
 In case of LAMA, consent is taken from the patient/ next of kin mentioning the reason for
LAMA.
2. PURPOSE
To guide discharge process effectively.
3. SCOPE
Hospital wide.
4. RESPONSIBILITY
Floor managers, Nurses, primary consultant, RMO, Emergency medical officer.
5. PROCEDURE
5.1. Discharge of patient from the hospital can be classified as follows:
a. Normal discharge (Cash Discharge/ Insurance Discharge / Corporate Discharge)

b. Transfer
c. LAMA & DAMA
d. Death
e. Discharge in case of Medico Legal Cases
a. Normal Discharge Procedure:
 Whenever discharges of patient is decided by a consultant, a complete Discharge summary with

medications and follow up advice is written by Duty RMO.
 Family members are informed accordingly by concern nurse and floor manager.

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 The whole Billing Card is rechecked by the Floor Manager.

 Bed charges & doctor consultation charges are made entry in the Billing Card.
 The investigation reports are rechecked.
Due report slip (if any) is prepared by floor manager and the patient/patient’s NOK made
signed on the same. One copy of Due slip is given to the patient and another copy is
kept in the patient medical records.
 Other details such as consumables used are checked whether made entries in the Billing Card.
 OT entries are to be rechecked (if any).
 Bed side procedure or any departmental procedures to be entered in the system.
 Staff nurse send the unused medicine to the pharmacy using Medicine return slip along with
the Billing Card.
 Then the pharmacy made the clearance in the Billing Card and returns the same to the respective
ward.
 In case of corporate and TPA patient, one copy of discharge summary is to be sent to the billing
department along with the billing card.
 In case of corporate and TPA patient, the original reports are to be send to IPD In-charge for
submission to commercial department.
 Indoor billing department provides final bill to the patient relative which contains detail breakup
of all medical expenses.
 In case of cash patient, after receiving full payment from the patient’s NOK, clearance for
discharge is given from billing counter and same is handover to staff nurse by patient’s NOK.
 In case of Insurance/Corporate cases, bills are settled accordingly after receiving of pre-
authorization/ credit letters and the clearance for discharge is given to patient’s NOK.
 All the documents e.g. discharge summery, diet chart, investigation report are handed over to
the patient by the staff nurses and after receiving the accounts clearance slip from the patient’s
NOK.
 Discharge summary is explained by Sister in charge/ staff nurse, the dietician explains diet.
 Feedback form is given to the patient at the day of discharge and collected from the patient after
completing the whole discharge process by the floor manager.


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i. The different types of Normal discharge are:
a) Cash Discharge: When the patient is paying by cash during discharge it is called cash
discharge. Patient’s NOK are given final discharge bill. The balance amount is paid and the
due is cleared. The patient’s NOK are handed over the Discharge bill and clearance slip for
discharge with hospital stamp after clearance of all due amount, by which all the rest of the
documents is handed over from the respective ward.
b) Credit Discharge:
 Insurance Discharge: During cashless insurance discharge a valid authorization is

mandatory. The authorization has to have the clause mentioned in the approval. If the full
amount is granted by the insurance agency even then the standard non-reimbursable amounts
to be paid by the patient’s NOK at the time of discharge. As per the clause mentioned in the
authorization if some amount has to be collected from the patient, that amount is calculated
and conveyed to the patient’s NOK. The deposit amount is then taken in cash and Discharge
slip is generated. The patient’s NOK are provided with the duplicate detailed bill with
hospital stamp. Original discharge bill are signed by the patient relative & then it is sent to
commercial department with the credit letter attached.
 Corporate Discharge: For corporate credit discharge, a corporate letter stating all the
details of the clauses with the hospital is mandatory. All instructions should be clearly
mentioned in the credit letter. After showing the detailed bill to the patient’s NOK, and
verifying all the details according to the credit letter, patient is discharged. Discharge bill
are signed by the patient relative & then it is sent to commercial department with the credit
letter attached.
b. Transfer: Transfer of patients from NMH to any other hospital is done as per doctor’s advice or if
the facility is not available in the hospital. In this case discharge summary is handed over to patients
for further reference to other hospitals.
c. LAMA & DAMA:
 The process of LAMA is initiated by the patient / patient’s NOK through verbal communication
to the Primary Consultant/ Duty RMO.
 LAMA is mentioned in the treatment sheet by the Primary consultant/ Duty RMO.

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 LAMA form duly filled up by the patient’s NOK and to be counter signed by Nursing director,
Operation manager and Medical Administration respectively.
 In the billing card also, LAMA is mentioned by the Floor Manager.
 For rest of the discharge process follow planned discharge portion.
d. Death:
 The death intimation is given by the Primary Consultant/Duty RMO to the patient’s NOK.
 Death summary is mentioned in the progress notes by Duty RMO.
 Verification of the spelling of the patient name, age, sex and address to be done by the patient’s
NOK for preparation of the death certificate.
 Death Certificate to be prepared by duty RMO mentioning cause of death and handed over to the
patient’s NOK after receiving the Clearance slip from billing department.
 Manager- Operation is intimated about death by IPD in-charge.
 For rest of the discharge process follow planned discharge portion (excluding discharge summary
portion).
e. Discharge In case of Medico Legal Case:
 In case of MLC LAMA, patient’s NOK writes an application to Medical superintendent which
is forwarded to local Police station by Medical superintendent for NOC. The application is
carried to local Police station by patient NOK and one hospital representative.
 Local police station gives NOC along with the stamp on the application and sent back to the
hospital for LAMA procedure.
 For rest of the discharge process follow LAMA discharge portion.
 In case of MLC death, local PS discretion whether the body will be handed over to the police for
PM or will be handed over the patient’s NOK.


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2. POLICY & PROCEDURE FOR ABSCONDED CASES
1. POLICY
Patients, who have left the ward without staff’s knowledge for more than 2 hours, are to be
considered as absconded from NMH. Staff of NMH shall ensure the intimation of the same to
Security, Local Police station as well as to the next of Kin to avoid violence.
2. PURPOSE
To provide guidance on the measures and actions to be taken and by whom, in the event of a patient
being identified as Missing/Absconded in NMH.
3. SCOPE
This Policy and Procedure is applicable for Inpatient services in the hospital.
4. RESPONSIBILITY
All staff involved in patient care shall be responsible for the implementation of this policy.
5. PROCEDURE
a. Procedure for assessment of risk of absconding patients
 Patients identified as missing/absconding shall be assessed for any harm or posing any threat
either to themselves or others.
 Patient who has been assessed is likely to attempt significant self-harm or suicide based on all
relevant information indicating the individual’s state of mind and medical history.
b. Procedure for management of absconding patients
 Search immediate area/bed area to establish whether a patient has taken belongings with them.
 Assess whether the absconded patient pose any harm or threat to him or other.
 Inform the security to alert the main entrance and exit.


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 Inform Medical Superintendent and respective departmental staff like Manager Operations,
Nursing Director, Security In-charge.
 Inform the RMO on duty who will provide/confirm clinical opinion regarding risk assessment.
 Call in the telephone numbers furnished by the patient / Next of Kin at the time of admission,
or as entered in the system.
 Lodge an FIR in Local Police station in writing in hospital Letter Head, receipt copy to be
maintained in patient file.
 Complete Incident Form and document in patients medical records.
c. Procedure when absconded patient is found
 Seek information about patient’s condition and whether they intend to return to hospital.
 If patient returns to the hospital or agrees to return then Medical or nursing assessment (as
appropriate) shall be done and treatment shall be provided as required.
 Immediate contact shall be made with the patient’s NOK.
 Assess whether there is further risk of patient absconding.
 If patient refuse to return to hospital then this shall be discussed by the Medical Superintendent
and respective departmental staff like Manager operations, Nursing Director, Security In- charge
with the medical team or concerned consultant.
 Complete the incident report form and document in the medical records of the patient.
 The analysis report shall be communicated to all concerned.


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3. LIST OF DOCUMENTS
FORMS
SL NO. FORM NAME FORM ID
1 Medico Legal Case Report NMH/COP/FM/MLC_Rpt/Ver.1/0124
2 Consent For Leave Against Medical Advice (LAMA) NA
3 Billing Card NMH/AAC/CARD/Bill/Ver.1/0923
REGISTERS
SL NO. REGISTER NAME REGISTER ID
1 MLC Register NMH/EMG/RG/2
FILES
SL NO. FILE NAME FILE ID
NA NA NA
4. REFERENCES
National Accreditation Board For Hospitals & Healthcare Providers (5th edition)
5. ABBREVIATION
1. MLC- Medico Legal Cases

2. LAMA- Leave Against Medical Advice
3. RMO- Resident Medical Officer
4. OT- Operation Theatre
5. TPA-Third Party Administrator
6. NMH- Narayan Memorial Hospital
7. PS- Police Station
8. FIR- First Information Report
9. ID- Identification
10. RMO- Resident Medical officer
11. NOK- Next Of Kin
12. IPD- In Patient Department
13. NOC- No Objection Certificate


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NARAYAN MEMORIAL HOSPITAL Document No.

(A UNIT OF NARAYAN HEALTH SERVICES PVT. LTD.) NMH/AAC/QSP/3

POLICY & PROCEDURE FOR DISCHARGE OF PATIENT INCLUDING

POLICY & PROCEDURE FOR DISCHARGE OF

NARAYAN MEMORIAL HOSPITAL

Issue No: 01 Version No: 1

POLICY & PROCEDURE FOR DISCHARGE OF PATIENT INCLUDING

DOCUMENT REVISION HISTORY

Issue No: 01 Version No: 1

POLICY & PROCEDURE FOR DISCHARGE OF PATIENT INCLUDING

2 POLICY & PROCEDURES FOR ABSCONDED CASES 8

Issue No: 01 Version No: 1

POLICY & PROCEDURE FOR DISCHARGE OF PATIENT INCLUDING

1. POLICY & PROCEDURE FOR DISCHARGE OF PATIENT INCLUDING MLC

To guide discharge process effectively.

Floor managers, Nurses, primary consultant, RMO, Emergency medical officer.

5.1. Discharge of patient from the hospital can be classified as follows:

a. Normal discharge (Cash Discharge/ Insurance Discharge / Corporate Discharge)

a. Normal Discharge Procedure:

 Whenever discharges of patient is decided by a consultant, a complete Discharge summary with

POLICY & PROCEDURE FOR DISCHARGE OF PATIENT INCLUDING

 The whole Billing Card is rechecked by the Floor Manager.

Issue No: 01 Version No: 1

POLICY & PROCEDURE FOR DISCHARGE OF PATIENT INCLUDING

i. The different types of Normal discharge are:

 Insurance Discharge: During cashless insurance discharge a valid authorization is

c. LAMA & DAMA:

POLICY & PROCEDURE FOR DISCHARGE OF PATIENT INCLUDING

e. Discharge In case of Medico Legal Case:

Issue No: 01 Version No: 1

POLICY & PROCEDURE FOR DISCHARGE OF PATIENT INCLUDING

2. POLICY & PROCEDURE FOR ABSCONDED CASES

a. Procedure for assessment of risk of absconding patients

b. Procedure for management of absconding patients

Issue No: 01 Version No: 1

POLICY & PROCEDURE FOR DISCHARGE OF PATIENT INCLUDING

c. Procedure when absconded patient is found

Issue No: 01 Version No: 1

POLICY & PROCEDURE FOR DISCHARGE OF PATIENT INCLUDING

1. MLC- Medico Legal Cases

Issue No: 01 Version No: 1

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