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Here is the full transcription of the discharge instructions form:
PERPETUAL HELP MEDICAL CENTER - LAS PIÑAS
DISCHARGE INSTRUCTIONS
(FM-ERD-001-7/3 19-MAY-2026)
NAME OF PATIENT: Caralonte, John Rafael
AGE: 6
GENDER: M
DATE OF BIRTH: (blank)
HOSPITAL NO.: (blank)
VITAL SIGNS
| BP | PR | RR | TEMP | PAIN | |
|---|---|---|---|---|---|
| INITIAL | 120/70 | 143 | 22 | 37.9 | /10 |
| FINAL | 110/70 | 120 | 21 | 36.7 | /10 |
WORKING IMPRESSION:
Acute tonsillo-pharyngo-exudative
DIAGNOSTIC TESTS:
- CBC
- Urinalysis
- Stool Exam
- CBG
- CXR
- 12 Lead ECG
- Others
MEDICATIONS GIVEN: /
REMARKS:
Upon discharge, stable condition. Risk and consequences explained and understood. Well advised.
May follow-up official result at Radiology dept. after 24 hours onwards:
( ) N/A ( ) X-ray ( ) CT-Scan ( ) MRI
HOME MEDICATIONS
| GENERIC AND TRADE NAMES | DOSAGE/PREPARATION | FREQUENCY | TIME |
|---|---|---|---|
| Co-amoxiclav | 457 mg / 5mL | Give 7 mL every 12 hours x/after for 7 days | |
| Paracetamol | 250 mg / 5mL | Give 2 mL every 4 hours as needed for fever ≥ 37.8°C |
WAIVERS:
- Refused Medications
- Refused Procedures
- Refused Admissions
- Home Against Advise
- Transfer to Hospital of Choice
DISCHARGE INSTRUCTIONS
DIET: As tolerated, increase oral fluid intake
HOME CARE (Monitoring, Wound care and Dressing, Baths):
Worsening of symptoms
PHYSICAL ACTIVITY (Restrictions, Precautions, Mobility, Exercises):
Avoid strenuous activities
OTHERS (What to watch for, What to avoid, Restrictions):
Persistent high fever ≥38.5, chills, cold/clammy feeling, weakness, difficulty in breathing, difficulty in swallowing, decrease in appetite
Come back to any ER anytime.
DISPOSITION:
- Fit to work
- Rest for Three Days (3)
- Follow-up on:
- Follow-up with Doctor of choice (Pedia)
DISCHARGE DATE: 7/12/2026
DISCHARGE TIME: 8:07 AM
ED CONSULTANT: Dr. Libang
RESIDENT/S: Pelais / Anderson
AS EXPLAINED BY: (Signature) - Emergency Medicine, Lic. No. 0178754
PRINTED NAME AND SIGNATURE OF PATIENT/REPRESENTATIVE:
Anne Jane Caralonte
RELATIONSHIP: Mother
DATE: 7/12/2026
"In compliance with the Data Privacy Act of 2012 (RA 10173), all data / information gathered from the patient shall be treated confidential and shall only be used for the purposes of his/her treatment."
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