Table 3 Final Items for the Discharge Prescription Section of the D-SAFE Model

1. Community or institutional pharmacy pre-hospitalization

   1.1. Phone number

   1.2. Fax number

2. Allergies

3. Drug intolerances

4. CrCl (mL/min)

   4.1. Date

5. Creatinine

6. Weight (Kg)

   6.1. Date

7. Signature of the pharmacist doing the Rx history

   7.1. Phone number

   7.2. Pager

   7.3. Date

8. Medication prior to admission

   8.1. Name

   8.2. Comments

   8.3. Specify if continuing/modifying/stopping

   8.4. Length (number of days)

   8.5. Renewal (number)

9. Changes/new medications at discharge and narcotics

   9.1. Name

   9.2. Indications

   9.3. Length (number of days)

   9.4. Renewal (number)

10. Specify if weekly pill box

11. Barriers to patient's compliance (vision, hearing, manual dexterity, cognition, complex dosing regimen)

12. Physician's signature

   12.1. Name in print

   12.2. Licence number

   12.3. Phone number

   12.4. Fax number

   12.5. Date

13. Notes for the community or institutional pharmacist

14. Prescription verified by the pharmacist before patient discharge