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  • WHAT WE DO
    • Stabilization
      • Rural Outreach
        • Mobile Resource Bus
        • Kids Summer Food Program
      • Family Support Centers
      • Shalom House – Men’s Shelter
      • Refugee and Immigration Services
      • La Luz Immigration Clinic
      • TurnStyles Thrift
      • Financial Education
    • Strengthening
      • Foster Grandparents
      • Financial Education
      • Refugee Employment Services
      • Refugee Learning Center
      • New Roots for Refugees
      • St Rita Program
    • Respect Life Services
      • Adoption
      • Pregnancy Counseling
      • Catholic Community Hospice
      • In-Home Support
  • WHERE WE WORK
    • Family Support Centers
      • Kansas City, KS
      • Atchison
      • Leavenworth
      • Lawrence
      • Olathe
      • Overland Park
      • Topeka
      • Mobile Resource Bus
      • Shalom House – Men’s Shelter
      • Hope Distribution Center (HDC)
    • Healthcare Offices
      • Hospice Office – Kansas
      • Hospice Office – Missouri
    • Turnstyles Thrift Stores
      • Martway in Mission
      • 87th Street
      • 135th & Nieman
      • ebay Online Store
  • GET INVOLVED
    • Special Events
      • The Gathering
      • Snow Ball
      • Grace and Gratitude Virtual Rosary
      • Golf Classic
    • Volunteer
    • Ways to Engage
    • Give Hope
    • Outreach and Advocacy
    • M25: Monthly Giving
    • Leadership Giving
    • Cars 4 KC
    • Amazon Smile
    • Gifts In Kind
  • ABOUT US
    • Media Center
      • Good News
      • In The News
      • Hope Stories
      • Hope Notes: E-Newsletter
      • Breaking Bread – Catholic Charities’ Print Newsletter
      • Photos & Videos
      • Media Kit
    • Finances
      • IRS 990 Reports
      • Financial Audit Reports
      • Annual Reports
        • Our People
    • Careers
    • Contact Us
  • DONATE
  • WHAT WE DO
    • Stabilization
      • Rural Outreach
        • Mobile Resource Bus
        • Kids Summer Food Program
      • Family Support Centers
      • Shalom House – Men’s Shelter
      • Refugee and Immigration Services
      • La Luz Immigration Clinic
      • TurnStyles Thrift
      • Financial Education
    • Strengthening
      • Foster Grandparents
      • Financial Education
      • Refugee Employment Services
      • Refugee Learning Center
      • New Roots for Refugees
      • St Rita Program
    • Respect Life Services
      • Adoption
      • Pregnancy Counseling
      • Catholic Community Hospice
      • In-Home Support
  • WHERE WE WORK
    • Family Support Centers
      • Kansas City, KS
      • Atchison
      • Leavenworth
      • Lawrence
      • Olathe
      • Overland Park
      • Topeka
      • Mobile Resource Bus
      • Shalom House – Men’s Shelter
      • Hope Distribution Center (HDC)
    • Healthcare Offices
      • Hospice Office – Kansas
      • Hospice Office – Missouri
    • Turnstyles Thrift Stores
      • Martway in Mission
      • 87th Street
      • 135th & Nieman
      • ebay Online Store
  • GET INVOLVED
    • Special Events
      • The Gathering
      • Snow Ball
      • Grace and Gratitude Virtual Rosary
      • Golf Classic
    • Volunteer
    • Ways to Engage
    • Give Hope
    • Outreach and Advocacy
    • M25: Monthly Giving
    • Leadership Giving
    • Cars 4 KC
    • Amazon Smile
    • Gifts In Kind
  • ABOUT US
    • Media Center
      • Good News
      • In The News
      • Hope Stories
      • Hope Notes: E-Newsletter
      • Breaking Bread – Catholic Charities’ Print Newsletter
      • Photos & Videos
      • Media Kit
    • Finances
      • IRS 990 Reports
      • Financial Audit Reports
      • Annual Reports
        • Our People
    • Careers
    • Contact Us
  • DONATE

CATHOLIC COMMUNITY HOSPICE

Hospice Volunteer Site Visit Form

Volunteer Visit FormCCNEK Marketing2017-08-25T18:07:41-05:00

Hospice Site Visit Form

The hospice site visit form is available to volunteers to report their patient visit results to Catholic Community Hospice employees.

  • Visit Information

  • Enter your first and last name.
  • Enter the first and last name of the hospice patient
  • Date Format: MM slash DD slash YYYY
    Enter the date that the patient visit occurred
  • :
  • :
  • :
    Enter the amount of round-trip travel time it takes you to drive from your location to the patient's location. For example, if it takes you 20 minutes to drive to the patient, then the round-trip travel time is 0 hours and 40 minutes.
  • Enter the number of round-trip miles it takes you to drive from your location to the patient's location. For example, if you travel 20 miles to drive to the patient from your location, then the round-trip travel mileage is 40 miles.

  • Location

  • Enter the name of the caregiver or facility location.
  • Select the type of patient visit - by phone, in-person, or others.
  • Type in your own choice for "Type of Contact"
  • Select the type of patient visit - home, hospital, nursing home, or other
  • Type your own choice for "Type of Contact Location"

  • Patient Wellness

    Select the type of communication you had with the patient. Check all that apply.
  • Type your own choice for "Type of Communication"
    Select all the ways the patient appeared to you. Check all that apply.
  • Type your own choice for "Mental Status"
    Select all the ways the patient's needs were being met. Check all that apply.
  • Type your own choice for "Physical Status"

  • Is the Patient in Pain?

    If you see a patient that is in pain please contact a hospice nurse ASAP at 913.621.5090 and make a note of it in the comments section below.
    Check all that apply.
  • Type your own choice for "Patient Services"
    Check all that apply.
  • Type your own choice for "Activities"
  • Enter any other comments or notes about the visit.

HOSPICE QUICK LINKS

  • Hospice Overview
    • Patients and Families
    • Healthcare Providers
    • Grief Support
    • FAQ
    • Donate
    • Volunteer
    • Contact Hospice

OUR WORK

  • Adoption
  • Catholic Community Hospice
  • Financial Education
  • Foster Grandparents
  • In-Home Support
  • Kids Summer Food Program
  • Pregnancy Counseling
  • Refugee and Immigration Services
  • TurnStyles Thrift

OUR LOCATIONS

  • Atchison FSC
  • Hope Distribution Center (HDC)
  • Kansas City FSC
  • Lawrence FSC
  • Leavenworth FSC
  • Olathe FSC
  • Overland Park FSC
  • Shalom House – Men’s Shelter
  • Topeka FSC
  • Mobile Resource Bus

OUR SUPPORTERS

  • Volunteer
  • Leadership
  • Partnerships
  • Privacy Policy
  • Contact Us
  • Careers
  • Donate
  • Trustees Portal
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  • Log In
© Copyright 2012-- Catholic Charities of Northeast Kansas.
All Rights Reserved

   

M25: Mercy Multiplied

Our mission follows the Gospel of Matthew, verse 25: “Whatever you did for one of these least brothers of mine, you did for me.”

As a monthly donor to Catholic Charities of Northeast Kansas, you have the opportunity to receive a free t-shirt for yourself and another member of your household.

We will be in touch once you sign up. Questions? Please reach out to Gary Pratt, gpratt@catholiccharitiesks.org