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PALLIATIVE CARE WORKSHEET (TOOL #O1) Revised for Palliative Care in Nursing Homes Project Name Social Security # Location Date of Admission / / Demographic Information Age Race White Hispanic Religion

How to fill out palliative care worksheet

1. The first step in filling out a palliative care worksheet is to gather all the necessary information. This includes the patient's basic demographic information, medical history, current diagnosis, and treatment plan.
2. Next, it is important to review the goals of care with the patient and their family or caregivers. This involves discussing the patient's preferences, values, and priorities in order to develop a personalized care plan.
3. The palliative care worksheet typically includes sections for documenting the patient's physical symptoms, such as pain, fatigue, and shortness of breath. It is important to accurately assess and document the severity of these symptoms using a standardized rating scale if available.
4. The worksheet may also include sections for documenting the patient's emotional and psychological symptoms, such as anxiety, depression, or distress. It is important to listen to the patient and their caregivers and document their concerns and needs.
5. Another important aspect of the palliative care worksheet is documenting the patient's functional status. This includes assessing their ability to perform daily activities such as eating, bathing, and dressing. It is important to assess any changes or decline in their functional abilities.
6. Communication is a key component of palliative care, so it is important to document any discussions or conversations with the patient and their family or caregivers. This includes discussing treatment options, setting realistic goals, and addressing any concerns or questions.
7. In addition to documenting the patient's symptoms and functional status, the palliative care worksheet may also include sections for documenting their medications, including prescription medications, over-the-counter medications, and any complementary or alternative therapies they may be using.
8. Finally, it is important to regularly review and update the palliative care worksheet as the patient's condition or needs change. This ensures that the care plan remains current and responsive to the patient's evolving needs.

As for who needs a palliative care worksheet, it is typically used by healthcare professionals involved in the patient's palliative care team. This may include doctors, nurses, social workers, and other members of the healthcare team. The worksheet helps facilitate communication and coordination among team members, ensuring that the patient's care is comprehensive and holistic.

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What is palliative care worksheet?

Palliative care worksheet is a tool used to assess and document the needs and preferences of patients with serious illnesses.

Who is required to file palliative care worksheet?

Healthcare providers and facilities are required to fill out and file the palliative care worksheet for qualifying patients.

How to fill out palliative care worksheet?

The palliative care worksheet should be filled out with input from the patient, their family members, and healthcare team based on the patient's needs and preferences.

What is the purpose of palliative care worksheet?

The purpose of the palliative care worksheet is to ensure that patients receive appropriate care that aligns with their goals, values, and preferences.

What information must be reported on palliative care worksheet?

The palliative care worksheet should include information about the patient's medical condition, treatment options, goals of care, and preferences for symptom management.

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