Ms. Wu: follow-up after discharge (anonymised)

This is a process note, not a recovery plan. Ms. Wu's father had been discharged in Lecheng and was home in another city. She was the one watching the next few weeks. Names are removed.

What was hardest

The discharge pack was thick. The date that mattered was on one page inside it. At home, days were busy, and at night she was no longer sure what to bring or whom to call. She did not want the whole family searching a chat log each time.

The handover list

Before they left the hospital, Leyitong copied the follow-up timing already written in the discharge note onto one page: around which day to get in touch, which earlier reports to carry, and who the contact was. The list added no extra tests. Dates the doctor had not written were not invented. Medicines stayed on the hospital orders. The list only said to follow those orders and to call the hospital or the hotline if something felt wrong. It did not change doses.

After they were home

Before the date, the contact reminded her once and asked whether the reports were in hand and whether a local appointment still needed booking. One night she called because her father felt unwell. The contact did not judge how serious it was on the phone. She was pointed to local emergency care or the original hospital's urgent line. What Leyitong could still do in office hours was written down: whether to book another video consult, and which page was still missing.

The edge of the sheet

Follow-up here is reminders and the next booking. It is not round-the-clock nursing and it does not replace the local hospital. The confirmation said how many check-ins and until which day. After that, continuing would be a new sheet.