Chart summary examples on 1 synthetic chart
Short version: below is 1 synthetic chart (no real patient) summarized 4 ways: a nephrology consult, a transfer between hospitals, a discharge summary and a pre-visit summary for the primary care follow-up. The same 14 chart entries feed all 4, but each summary keeps different ones on top. 3 traps are planted in the chart: a held medication, a lung nodule found by accident, and a lab result that came back after the patient left. Watch where each one lands.
Limits: Vendor facts come from each vendor's own website on 2026-11-12 and were not tested by us. Rules are summarized from the cited text; your hospital's bylaws, payer contracts and state law can ask for more.
Synthetic, no real patient. The patient, hospitals, dates, values and page numbers are invented for teaching. The plan details show how a summary records a chart's plan; they are not treatment advice.
The synthetic chart: 14 entries across 2 hospitals
Patient S., 71, woman. Known heart failure with reduced ejection fraction (EF 30% on an echo from 2026-03-14), atrial fibrillation on apixaban, type 2 diabetes, chronic kidney disease stage 3a (baseline creatinine 1.3 mg/dL), hypertension. Allergy: penicillin, hives. Home medications: sacubitril/valsartan 49/51 mg twice daily, metoprolol succinate 100 mg daily, furosemide 40 mg daily, apixaban 5 mg twice daily, metformin 500 mg twice daily, atorvastatin 40 mg daily. Last clinic visit 2026-09-02, weight 78.0 kg.
| Date | Entry | Source |
|---|---|---|
| 2026-10-04 | ED, Hospital A: 5 days of worsening breathlessness, orthopnea, weight 84.0 kg. BP 104/68, HR 112 irregular, SpO2 90% on room air. BNP 2,450 pg/mL, creatinine 1.9, potassium 5.4. Chest X-ray: pulmonary edema, small effusions. | A p. 38-44 |
| 2026-10-04 | CT angiogram of the chest: no pulmonary embolism. 9 mm solid nodule, right upper lobe. Radiologist recommends CT chest in 3 months. | A p. 52 |
| 2026-10-04 | Admitted. Metformin held (kidney injury, IV contrast). Sacubitril/valsartan held (kidney injury, potassium 5.4). IV furosemide 40 mg twice daily. Code status full code, confirmed with patient; daughter is health care proxy. | A p. 41, 55 |
| 2026-10-05 | Nephrology consult requested: "AKI on CKD, is it safe to keep diuresing?" | A p. 60 |
| 2026-10-05 | Nephrology note: urine sodium 18 mmol/L, bland sediment. Impression: kidney injury from congestion, not tubular injury. | A p. 61-63 |
| 2026-10-06 | Echo: EF 25%. Net fluid balance minus 2.1 L. Creatinine 1.8, potassium 4.9. Iron studies sent. | A p. 70-72 |
| 2026-10-07 08:00 | Atrial fibrillation, rate 130 to 145. IV metoprolol at 07:40, then BP 88/56. Metoprolol held. Last apixaban dose 08:00. | A p. 75 |
| 2026-10-07 11:10 | Digoxin 0.25 mg IV once. Rate 105 to 115, BP 96/62. | A p. 76 |
| 2026-10-07 14:30 | Transfer to Hospital B for advanced heart failure evaluation; Hospital A has no advanced heart failure service. | A p. 78-80 |
| 2026-10-09 | Iron studies result at Hospital A: ferritin 48 ng/mL, transferrin saturation 14%. Filed to the Hospital A chart after transfer. Not sent to Hospital B. | A p. 84 |
| 2026-10-07 to 10-11 | Hospital B: IV furosemide infusion, net minus 6.3 L. Metoprolol succinate restarted 50 mg daily on 10-09. Sacubitril/valsartan restarted 24/26 mg twice daily on 10-11. Metformin restarted 10-11. Advanced heart failure team: not a candidate for advanced therapies now; follow in heart failure clinic. | B p. 12-88 |
| 2026-10-12 | Discharged home with home health, walking without oxygen. Weight 77.5 kg. Creatinine 1.4, potassium 4.6, BNP 610. Furosemide now 40 mg twice daily. Full code. | B p. 90-96 |
| 2026-10-15 | Home health blood draw: creatinine 1.5, potassium 4.8. | Clinic p. 3 |
| 2026-10-19 | Heart failure clinic visit booked. 2026-10-20 primary care visit booked. | B p. 95 |
Example 1: consult summary (nephrology, 2026-10-05)
Question (as asked): Kidney injury on CKD 3a during IV diuresis for heart failure. Is it safe to keep diuresing?
Answer: Yes. The pattern fits kidney injury from congestion, not tubular injury: urine sodium 18 mmol/L, bland sediment, creatinine 1.9 from a baseline of 1.3 with a 6 kg weight gain. Kidney function should improve as congestion clears.
Recommendations: 1. Continue IV furosemide; target net negative 1 to 2 L a day. 2. Basic metabolic panel daily. 3. Keep sacubitril/valsartan and metformin held until creatinine is falling and potassium is below 5.0. 4. Avoid further IV contrast for 72 hours.
If things change: if creatinine rises by 0.3 or more with no weight loss, or potassium goes above 5.5, call nephrology the same day.
Basis: HPI and exam as above; urine studies 2026-10-05 (A p. 61); allergies: penicillin (hives).
Follow-up: we will see the patient again on 2026-10-07.
What it leaves out on purpose: the lung nodule, the diabetes plan and the full medication list. None of them bears on the question. Why it works: the answer is in line 2, the recommendations are numbered and specific, and there is a plan for the night.
Example 2: transfer summary (Hospital A to Hospital B, 2026-10-07 14:30)
Reason for transfer: decompensated heart failure (EF 25%) with atrial fibrillation and rapid rates, now with low blood pressure. Needs advanced heart failure evaluation, which Hospital A doesn't offer.
Illness severity: watcher. Last vitals 14:00: BP 96/62, HR 108 irregular, SpO2 94% on 2 L.
Course: admitted 10-04 with pulmonary edema, 6 kg over baseline weight. IV furosemide, net minus 2.1 L. Kidney injury (creatinine 1.9, now 1.8) judged congestive by nephrology; diuresis continued.
Medications given today: metoprolol IV at 07:40, then BP 88/56; metoprolol now held. Digoxin 0.25 mg IV at 11:10. Apixaban 5 mg at 08:00 (next due 20:00).
Held home medications: sacubitril/valsartan (kidney injury, potassium), metformin (kidney injury, contrast), metoprolol succinate (low BP).
Allergies: penicillin, hives.
Results: BNP 2,450 (10-04). Creatinine 1.9 to 1.8, potassium 5.4 to 4.9. Echo EF 25% (10-06). CT chest 10-04: no pulmonary embolism; 9 mm right upper lobe nodule, CT in 3 months advised.
Pending: iron studies sent 10-06. Result will go to Dr. [sending physician], who will forward it to Hospital B.
Code status: full code, confirmed 10-04. Proxy: daughter [phone].
Contact: sending hospitalist [callback number].
What it leaves out on purpose: the day-by-day course and the full ED workup. Trap 1, the held medications: listed with reasons, so Hospital B knows they were stopped on purpose and when to restart them. Trap 2, the nodule: carried forward here, because a transfer is where incidental findings get lost. Trap 3, the pending iron studies: it names who forwards the result. In the chart above, that handoff still failed on 10-09. A summary can assign the task; it can't do it.
Example 3: discharge summary (Hospital B, 2026-10-12)
Reason for hospitalization: acute on chronic heart failure with reduced EF, atrial fibrillation with rapid rates.
Discharge diagnoses: 1. Acute on chronic HFrEF, EF 25%, improved. 2. Atrial fibrillation, rate controlled. 3. Kidney injury on CKD 3a from congestion, improving (creatinine 1.9 peak, 1.4 at discharge). 4. Pulmonary nodule, 9 mm, right upper lobe, incidental. 5. Type 2 diabetes.
Hospital course by problem: heart failure: IV furosemide at Hospital A, then infusion here; net minus 6.3 L; weight 84.0 to 77.5 kg. Advanced heart failure team: not a candidate for advanced therapies now. Atrial fibrillation: rates controlled after metoprolol restarted at a lower dose. Kidney: improved with decongestion, as nephrology predicted.
Consults: nephrology (Hospital A, 10-05); advanced heart failure (Hospital B, 10-08).
Medication changes: CHANGED furosemide 40 mg daily to 40 mg twice daily (congestion). CHANGED metoprolol succinate 100 mg to 50 mg daily (low BP 10-07). CHANGED sacubitril/valsartan 49/51 mg to 24/26 mg twice daily (restarted 10-11 after kidney injury). RESTARTED metformin 500 mg twice daily (10-11). UNCHANGED apixaban 5 mg twice daily, atorvastatin 40 mg daily. Digoxin given once at Hospital A, not continued.
Pending at discharge: iron studies sent at Hospital A on 10-06. Result not received here. Primary care to obtain it from Hospital A.
Incidental finding: 9 mm right upper lobe nodule (CT 10-04, Hospital A). Radiologist advised CT chest in 3 months, due around 2027-01-04. Owner: primary care.
Condition and disposition: walking on the ward without oxygen. Home with home health.
Follow-up: home health blood draw 10-15 (creatinine, potassium). Heart failure clinic 10-19. Primary care 10-20.
Told to the patient: weigh daily; call the heart failure clinic for a gain of 2 kg in 3 days; new pill doses reviewed with patient and daughter.
Code status: full code.
What it leaves out on purpose: the hour-by-hour events of 10-07 and every daily lab. Why it works: every medication is marked, the pending result has an owner, the nodule has a due date and an owner, and the hospital course reads by problem. Those are the 4 places Kripalani's 2007 review found discharge summaries fail most.
Example 4: pre-visit summary (primary care, prepared 2026-10-17 for 2026-10-20)
Visit: hospital follow-up. Last seen here 2026-09-02 (weight 78.0 kg).
What changed: admitted 10-04 to 10-12, Hospital A then Hospital B, for heart failure. EF now 25% (was 30%). Discharge weight 77.5 kg. Heart failure clinic visit booked for 10-19, the day before this visit.
Medication changes: furosemide up to 40 mg twice daily; metoprolol succinate down to 50 mg; sacubitril/valsartan down to 24/26 mg twice daily; metformin restarted.
Results to review: 10-15 creatinine 1.5, potassium 4.8 (discharge 1.4 and 4.6). Iron studies from Hospital A, obtained by our nurse 10-17: ferritin 48 ng/mL, transferrin saturation 14%. Not addressed by either hospital.
Open loops: CT chest for the 9 mm nodule, due around 2027-01-04, not yet ordered. Heart failure clinic note from 10-19: request it before the visit.
Care gaps: no 2026-27 influenza vaccine on record.
What it leaves out on purpose: the hospital course detail; the discharge summary is a click away. Why it works: it surfaces the 2 items that fell through the gap between the hospitals, the iron studies and the nodule follow-up, before the visit instead of after it.
What the 4 examples show
- The same fact moves. The nodule is absent from the consult, a result in the transfer, a diagnosis with an owner in the discharge, and an open loop in the pre-visit summary.
- Pending results need a name, not a note. "Pending" with no owner is how the iron studies sat unread for 8 days.
- Medication lists need verbs. Changed, held, restarted, stopped. A list of current doses hides 4 changes.
Write your own with the templates, then check it with the omission checklist.