University of Chicago PEACE: Palliative Care Clinic Referral Letter
A one-page letter to the physician of a patient who was seen at the Peace Palliative Care Clinic, summarizing the clinic evaluation and offering several recommendations.
Clinical Care Tools - Care Plan
Palliative Excellence in Alzheimer's Care Efforts (PEACE)
University of Chicago Medical Center
Section of Geriatrics (MC 6098)
5841 South Maryland Ave.
Chicago, IL 60637
Gavin W. Hougham, Research Director
Greg A. Sachs, Chief, Section of Geriatrics
How the grantee used this instrument:
This letter informed the patient's referring physician that their patient was seen at the clinic, who accompanied them, a list of recommendations for care, and the date of the next visit. Each letter is customized to the specifics of each patient.
symptom management, assessment
To use this tool:
You may adapt this letter for your own clinical use without additional permissions.
Adapted for the PEACE project by Deon Cox-Haley and Lisa Maillard.
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 12 KB / 1 page (Viewing PDF files requires downloading and installation of the free Adobe Acrobat Reader.)
Posted August 2004
University of Chicago: PEACE overview page
# UCP11, type:care_plan
Promoting Excellence in End-of-Life Care is 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.