Promoting Excellence : PEACE - Patient Information Worksheet

Name:
University of Chicago: PEACE - Patient Information Worksheet

Description:
A two-part intake form used at the PEACE Palliative Care Clinic for patients suffering from dementia or other complex illnesses.

Category:
Clinical Care Tools - Clinical Assessment

Source:
Palliative Excellence in Alzheimer's Care Efforts (PEACE)
University of Chicago Medical Center
Section of Geriatrics (MC 6098)
5841 South Maryland Ave.
Chicago, IL 60637

Contact:
Gavin W. Hougham, Research Director
[email protected]

Greg A. Sachs, Chief, Section of Geriatrics
[email protected]

How the grantee used this instrument:
This intake form was designed specifically for the patient with complex illnesses and was used to summarize clinical and functional information from which to make recommendations.

Keywords:
quality of life, symptom assessment, care plan, health status

To use this tool:
You may print and copy this tool for your own use from this site. Please credit source.

References:
Adapted for the PEACE project by Deon Cox-Haley and Lisa Maillard.

To view this tool:
Left click on the download link to view the PDF document in your Web browser. Right-click on the download link to save the document to your computer.
pdf PDF 88 KB / 2 pages (Viewing PDF files requires downloading and installation of the free Adobe Acrobat Reader.)

Posted September 2004

University of Chicago: PEACE overview page


# UCP12, type:clinical_assessment


Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying people and their families. Visit PromotingExcellence.org for more resources.

Promoting Excellence logo and link to home page