Chaplain Care Notes

Routine PRN

Patient Name: HHC#: Visit Date:

Time: Length of Visit:

Location:

Home Nursing Home Assisted Living Inpatient Unit Other

Visit with:

Patient Spouse Son Daughter Other

Family:

Present Spiritual/grief needs discussed Decline to discuss spiritual needs at this time Not present

Follow up telephone call placed to family    Date/Time Name

Outcome Reference:

Anticipatory Grief (C701) Scope of Service/Support System (C505) Spiritual (A205)

Other

Spiritual Support provided to above individual(s) through:

prayer scripture reading hymn singing last rites review near death awareness

friendship facilitate family communication devotionals unresolved issues resolved issues

review assurance of faith explore feelings and issues encourage life review

Other

Additional Needs/Comments:

Plan:

Continue to offer spiritual support and patient/family in agreement with care plan

Will increase or decrease frequency of visits due to

Other

Chaplain

Name: Date:

 

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