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Palliative medicine / Healthcare in the United States / Palliative care / Advance health care directive / Medicine / Health / Hospice


PEACE PALLIATIVE CARE CLINIC PATIENT INFORMATION WORKSHEET DEMOGRAPHICS Last Name First Name
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Document Date: 2009-11-09 18:40:58


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Facility

PEACE Care Clinic / Hospitalization Other hospice / /

MedicalCondition

Diarrhea / Shortness of Breath / Constipation / Fatigue / Depression / Nausea/Vomiting / Patient Life-Defining Illness / /

MedicalTreatment

Surgery / tube feeding / /

Position

Physician / /

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