Promoting Excellence : CALL Care Patient Services Data Form

Supportive Care of the Dying: CALL Care Patient Services Data Form

A record of patient process of care and services received after being enrolled in CALL Care.

Evaluation Tools - Programmatic

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:
This form is completed at one month, three months, six months, each three months and/or 6 - 12 weeks after death. The form collects data on the number of days and length of stays in CALL Care, in hospitals, in critical care or post acute care facilities, and in hospice.

outcome measurement, care plan

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 32 KB / 2 pages (Viewing PDF files requires downloading and installation of the free Adobe Acrobat Reader.)

Posted October 2004

# SCD10, type:programmatic2

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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