Name:
University of Chicago: PEACE - Patient Information Worksheet
Description:
A two-part intake form used at the PEACE Palliative Care Clinic for patients
suffering from dementia or other complex illnesses.
Category:
Clinical Care Tools - Clinical Assessment
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
ghougham@medicine.bsd.uchicago.edu
Greg A. Sachs, Chief, Section of Geriatrics
gsachs@medicine.bsd.uchicago.edu
How the grantee used this instrument:
This intake form was designed specifically for the patient with complex illnesses
and was used to summarize clinical and functional information from which to
make recommendations.
Keywords:
quality of life, symptom assessment, care plan, health status
To use this tool:
You may print and copy this tool for your own use from this site. Please credit
source.
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 88 KB / 2 pages (Viewing PDF files requires downloading
and installation of the free Adobe
Acrobat Reader.)
Posted September 2004
University of Chicago: PEACE overview page
# UCP12, type:clinical_assessment
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.
