Supportive Care of the Dying: CALL Care Patient Referral Checklist
Patient referral form for CALL Care services to be filled out by site personnel.
Organizational Tools - Enrollment Criteria/Patient Identification
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
e-mail: [email protected]
How the grantee used this instrument:
Administered at intake of patient enrolling in CALL Care.
patient criteria, identifying patients, referrals
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 24 KB / 2 pages (Viewing PDF files requires downloading and installation of the free Adobe Acrobat Reader.)
Posted October 2004
# SCD07, type:enrollment_criteria
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.