GUIDE FOR CARE AND SUPPORT DURING SERIOUS ILLNESS
Chapter 3: Care at Home: Family, friends, and professionals
Daily Log
Most people with a serious illness will have more than one health-care provider. It may be family members, friends, health aides, and other professionals. The following log may be helpful to assure information is recorded and communicated to the next provider.
Caregiver: ________________________________________________
Association: _______________________________________________
Date: ______________________ Shift Hours: ___________________
For Questions Call: _________________________________________
Main Daily Goals:
Medications - (See DAILY MEDICATIONS LOG)
Diet:
| Food | Amount | Time of Day | Comments |
Activities:
| Activity | How Long | Time of Day | Comments |
Pain/Discomfort:
How bad?(1-10, 10 being the worst) _________ How Long _________
Time of day __________ Treatment/Result ______________________
Nausea/Constipation/Diarrhea:
Overall/Other Comments:
Created by Compassionate Choices.
Next page: Chapter 4: The Health Care System: Questions to ask about your health care system