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

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

Description:
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.

Category:
Clinical Care Tool - Advance Care Planning

Source:
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
www.careofdying.org

Contact:
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.

Keywords:
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.

References:
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 PromotingExcellence.org for more resources.

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