Get the free PATIENT FAMILY VISITOR NOMINATION FORM Please Print or

DUKE HEALTH RALEIGH HOSPITAL PATIENT / FAMILY/ VISITOR NOMINATION FORM (Please Print or Type Clearly) Name of Nominee: RN LPN Work Address or unit Location: Please state your reasons for nominating

How to fill out patient family visitor nomination

How to fill out patient family visitor nomination?

1. Obtain the nomination form: The first step in filling out a patient family visitor nomination is to obtain the nomination form from the appropriate healthcare facility. This form may be available on the facility's website or can be obtained in person.
2. Read the instructions: Before filling out the nomination form, carefully read the instructions provided. These instructions will guide you on the required information, format, and any supporting documents that may be needed.
3. Fill out the patient details: Begin by filling out the required information about the patient for whom you are nominating a family visitor. This typically includes the patient's name, date of birth, and any unique identifiers such as a medical record number.
4. Provide your relationship to the patient: Indicate your relationship to the patient. This is important as it helps the healthcare facility assess the legitimacy and relevance of the family visitor nomination.
5. Explain the need for a family visitor: In this section, articulate why you believe a family visitor is necessary for the patient. Provide any relevant details about the patient's condition, support requirements, or emotional needs that necessitate the presence of a family member or loved one.
6. Nominee details: If you have a specific person in mind who you would like to nominate as the patient's family visitor, fill out their details in this section. Include their name, contact information, and relationship to the patient. If you do not have a specific nominee, leave this section blank.
7. Sign and date: Ensure you sign and date the nomination form as this signifies that the information provided is accurate to the best of your knowledge. Your signature also serves as consent for the healthcare facility to review and process your nomination.

Who needs patient family visitor nomination?

1. Patients requiring emotional support: Patients who are going through a challenging medical condition or procedure may greatly benefit from having a family member or loved one by their side for emotional support.
2. Patients with special needs: Patients with physical or intellectual disabilities may require the assistance and support of a family visitor during their time in the healthcare facility.
3. Pediatric patients: Children admitted to hospitals or undergoing medical treatments often find comfort and security in having a family member present. A family visitor can also aid in communicating the child's needs and preferences to the healthcare team.
4. Elderly patients: Elderly patients, especially those in long-term care facilities, often benefit from the presence of a family visitor to provide companionship, advocate for their needs, and ensure their wellbeing.
5. Palliative care patients: Patients receiving palliative care, which focuses on providing comfort and support during progressive and advanced illnesses, may require the presence of family members to enhance their quality of life and provide emotional support.
6. Mental health patients: Family visitors can play a crucial role in the recovery and treatment of mental health patients by providing support, reassurance, and connecting them to their social network outside of the healthcare facility.

It is important to note that the specific eligibility criteria for a patient family visitor nomination may vary depending on the policies of each healthcare facility. It is advisable to consult the facility's guidelines or speak with a healthcare provider for accurate and up-to-date information.

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What is patient family visitor nomination?

Patient family visitor nomination is a process where a patient can nominate individuals who are allowed to visit them during their hospital stay.

Who is required to file patient family visitor nomination?

The patient is required to file the patient family visitor nomination form.

How to fill out patient family visitor nomination?

To fill out the patient family visitor nomination form, the patient needs to provide the names and contact information of the individuals they wish to nominate.

What is the purpose of patient family visitor nomination?

The purpose of patient family visitor nomination is to regulate and manage visitor access to patients, ensuring their safety and comfort.

What information must be reported on patient family visitor nomination?

The patient must report the names and contact information of the individuals they wish to nominate as family visitors.