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A 78-year-old woman is being discharged after an admission with melaena. She takes apixaban for atrial fibrillation. Gastroscopy showed a bleeding duodenal ulcer, which was clipped; apixaban was withheld from admission, and the gastroenterology team intend to restart it two weeks after discharge once she has been reviewed. She goes home on pantoprazole. Your draft summary carries three patient identifiers, the admission and separation dates, the diagnoses, the procedure, a clinical synopsis, her penicillin allergy with the rash it caused, the discharge medicines and the date of her gastroenterology appointment. Which one of the following omissions is most likely to cause her harm?
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