Promoting Excellence : Modified City of Hope Family Questionnaire and CALL Care Cover Letters

Supportive Care of the Dying: Modified City of Hope Family Questionnaire and CALL Care Cover Letters

Two questionnaires for the patient enrolled in the CALL Care program assessing experiences in the following areas: physical, emotional, spiritual, health care environment, health care providers, and personal information. Includes an introductory cover letter to the family.

Clinical Care Tool - Advance Care Planning

Supportive Care of the Dying: A Coalition for Compassionate Care
c/o Providence Health System
4805 NE Glisan Street,2E07
Portland, Oregon 97213
tel: (503) 215-5053
fax: (503) 215-5054

Sylvia McSkimming
e-mail: [email protected]

How the grantee used this instrument:
Used to gather information for assessment of the patient and family at initial enrollment in the CALL Care Program and every six month afterwards.

values, continuity of care, emotional, psychological well-being, spiritual, family perception of care, psychosocial assessment

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

Developed specifically for this project by the project team.

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 1.15 MB / 10 pages (Viewing PDF files requires downloading and installation of the free Adobe Acrobat Reader.)

Posted October 2004

# SCD04, type:advanced_care_planning

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 for more resources.

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