Behavioral Health Discharge Planning Form

Behavioral Health Discharge Planning Form — Form Fields

This healthcare template includes 13 fields. Inpatient behavioral health teams complete discharge planning forms to ensure continuity of care after hospitalization. Free to customize and use on ZenBuild.

• Clinician Name (text, required)
• Clinician Email (email, required)
• Patient Full Name (text, required)
• Date of Birth (text, required)
• Discharge Date (text, required)
• Discharge Destination (dropdown selection, required) — options: Home - Alone, Home - With Family, Group Home, Step-Down Facility, Crisis Residential, Other
• Outpatient Therapy Scheduled? (dropdown selection, required) — options: Yes, No, Pending
• Medications Reconciled? (dropdown selection, required) — options: Yes, Partial, No
• Psychiatry Follow-Up Within 7 Days? (dropdown selection, required) — options: Yes, No, Patient Refused
• Case Manager Name (text, optional)
• Safety plan reviewed with patient (checkboxes, required)
• Crisis resources provided (checkboxes, required)
• Ongoing risks and notes for outpatient team (long text, required)