Hospice and Palliative Patient Volunteer Visit Form

Wednesday, May 19, 2021

Form Instructions and Reminders

Documenting Visits – 3 steps.  Keep answers brief.  If the situation was complicated, please call the Volunteer Coordinator or other staff member to explain. Remember these notes are added to the patient’s medical file. 

  1. What did you do?  What service did you provide? and What actions did you take?
    Examples are “I provided emotional support and got water for her to drink. We looked at a photo book and she shared about her childhood” (1 or 2 sentences is fine)
  2. What did you hear and see?  Does not include opinions, judgments, diagnosis. Use the term “as evidenced by” to share any changes in condition or unmet needs.
    If something you see or hear has an impact on patient care, please call our office immediately to report it.  Examples are pain, falls, and if the patient needs immediate help that a nurse, social worker, or other member of the team supports.  
  3. What was the result of the support/visit/phone call? Examples. “Bob said he got a good break and was appreciative”.  “Jane said she wanted me to call again next week” “

All visit reports must include time frame with patient, travel time, and be signed and dated by volunteer.

Ideally, reports are received within 48 hours of your visit or phone call.  

Visit frequency is put into the medical chart as part of the plan of care and must match the visits.  If a volunteer visit is canceled for any reason, it must be shared so it can be documented. Also include if there will be a change in your visit schedule.  

Keep all patient and family information in a location where others cannot see it either intentionally or accidentally. 

Contact Naomi Hirsch, Volunteer Coordinator

Work Cell:  541-602-8522 (text or call)
Front Desk: 541-757-9616
naomi.hirsch@luminahospice.org