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A Contact Sheet You Can Find at Night

Complete this with the hospice or palliative team. Keep a copy beside the phone and give one to anyone covering for you. It is not an advance directive, a DNR, or a medication chart.

Standalone Tool

My person's preferred name:

Where the care plan is kept:

Hospice / palliative service and daytime number:

After-hours number and backup number:

Symptoms or changes the team told us to call about:

What the team told us to do while waiting for a call back:

Who else has a copy of the team's instructions:

Our agreed contact after an expected death:

Person who can cover a visit or bring practical help:

Date the team reviewed this sheet: