Name:
University of Chicago PEACE: Palliative Care Clinic Referral Letter
Description:
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.
Category:
Clinical Care Tools - Care Plan
Source:
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
Contact:
Gavin W. Hougham, Research Director
[email protected]
Greg A. Sachs, Chief, Section of Geriatrics
[email protected]
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.
Keywords:
symptom management, assessment
To use this tool:
You may adapt this letter for your own clinical use without additional permissions.
References:
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.
